CLINICAL OBSTETRICS AND GYNECOLOGY
Volume 58, Number 4, 885–892
Postpartum Exercise
and Lactation
SUSAN M. BANE, MD, PhD
Department of Allied Health and Sport Studies, Barton College,
Wilson, North Carolina
Abstract: Many women who are breastfeeding also
want to participate in exercise, but have concerns
about the safety of their newborn. The following
chapter reviews issues related to postpartum exercise
and lactation. The goals of the chapter are to help
clinicians understand the benefits of exercise, examine
the impact of postpartum exercise on breastfeeding,
and provide practical recommendations for exercise
during the postpartum period in women who are
breastfeeding.
Key words: postpartum, exercise, lactation, breast-
feeding
The postpartum period can be one of the
most gratifying and exhausting times in a
woman’s life. The joy of motherhood is
mixed with the reality of interrupted sleep,
recovering from delivery, and unfamiliar-
ity of caring for a baby. These concerns,
along with many potential others, can
make the postpartum period extremely
stressful. It is important to teach women
to focus on their own health while breast-
feeding and caring for their newborn.
Fortunately, exercise is a simple and in-
expensive intervention that can play a
significant role in maximizing health and
wellness during the postpartum period
and beyond. This chapter focuses on
Correspondence: Susan M. Bane, MD, PhD, Depart-
ment of Allied Health and Sport Studies, Barton Col-
lege, Wilson, NC. E-mail: smbane@barton.edu
The author declares that there is nothing to disclose.
CLINICAL OBSTETRICS AND GYNECOLOGY
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Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
postpartum exercise and lactation. The
goals of the chapter are to help clinicians
understand: (1) the benefits of exercise, (2)
how postpartum exercise impacts breast-
feeding, and (3) recommendations for ex-
ercise during the postpartum period in
lactating women.
Benefits of Exercise
Exercise is defined as any movement that
is planned and done with the purpose of
maintaining or improving physical fit-
ness. Examples of exercise include walk-
ing, running, yoga, cycling, and resistance
training. Physical activity, in contrast, is
any bodily movement and includes activ-
ities such as yard work, walking up stairs,
carrying groceries, and exercise. Physical
activity and exercise are positively corre-
lated with overall fitness and can range
from light, moderate, to vigorous. Wash-
ing dishes would be considered light phys-
ical activity, and pushing a lawnmower
more moderate to vigorous. A slow walk
would be considered light exercise, where-
as a jog would be more moderate to
vigorous.1
A dose-response relationship exists be-
tween physical activity and health. This
simply means that doing something is
better than doing nothing. Someone who
/ VOLUME 58 / NUMBER 4 / DECEMBER 2015
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886 Bane

is completely inactive will have a higher effective treatment for controlling blood
risk for a variety of health issues com- glucose.8
pared with someone who is more active. Women who participate in at least
Thus, helping someone who is very sed- 30 minutes of moderate to vigorous aero-
entary increase activities of daily living bic activity during pregnancy are less
such as housework and yard work will likely to gain more than the recommended
improve health. Adding exercise to these amount of weight during pregnancy.9
activities of daily living will lead to greater This is particularly important given the
health benefits.1 National Health and Nutrition Examina-
Many of the vast physiological and tion Survey found that more than one half
psychological benefits of exercise and of pregnant women in the United States
physical activity are listed in Table 1.1–3 are overweight or obese.10 Appropriate
A broad range of health benefits have also weight gain during pregnancy is impor-
been noted before, during and after preg- tant to improve maternal health and birth
nancy.4,5 Exercise before and during preg- outcomes. Keeping weight gain within the
nancy is associated with lower risk for recommended amount helps avoid excess
preterm delivery, gestational diabetes, weight gain after pregnancy, development
and preeclampsia.6 Epidemiologic data of chronic disease, and optimizes birth
suggest that exercise may play a role in weight. Optimal birth weight lowers the
the prevention of gestational diabetes, risk of large for gestational age babies
especially in morbidly obese women with when mothers exercise during pregnancy,
a body mass index >33.7 In addition, leading to a reduction in potential injuries
women who are diabetic or get gestational to both the mother and baby during
diabetes can use exercise as a safe and delivery.11,12 Table 2 provides the recom-
mended ranges of weight gain and
are dependent on prepregnancy weight
status.13
TABLE 1. Health Benefits Associated With During the postpartum period many
Regular Physical Activity for women are eager to lose weight. This is
Adults important because several studies suggest
Physiological Psychological that pregnancy may be an important risk
factor for the development of obesity.
Decreased risk of type 2 Decreased Having 1 live birth increases the risk of
diabetes depression
Decreased risk of metabolic Adjunct treatment becoming moderately overweight by 60%
syndrome of depression
Decreased risk of coronary Decreased anxiety TABLE 2. Recommendations for Weight
heart disease Gain During Pregnancy
Decreased risk of high blood Adjunct treatment
pressure of depression Recommended
Decreased risk of stroke Improved sleep Prepregnancy Body Mass Weight Gain
Decreased risk of abnormal Enhanced mood Weight Index Range (lb)
blood lipid profile
Weight loss Improved body Underweight <18.5 28-40
image Normal weight 18.5-24.9 25-35
Weight maintenance Improved self- Overweight 25-29.9 15-25
concept Obese Z30 11-20
Prevention of weight gain Improved quality of
life Adapted by permission from The Institute of Medicine.13
Adaptations are themselves works protected by copyright. So
Increased bone density in order to publish this adaptation, authorization must be
Decreased risk of hip obtained both from the owner of the copyright in the original
fracture work and from the owner of copyright in the translation or
adaptation.

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and becoming obese by 110%.14 Weight
retention after pregnancy increases the
risk of chronic disease and exercise during
the postpartum period has been found to
help with weight loss. Less weight reten-
tion both at 6 weeks postpartum and 1
year have been demonstrated in women
reporting greater amounts of physical
activity.5
The psychological benefits of physical
activity in the general population have
been studied extensively.3 While there
are fewer studies during pregnancy and
the postpartum period, there is evidence
to suggest that women who participate in
regular exercise during these times also see
psychological benefits. Postpartum de-
pression is an important public health
issue. An estimated 6% to 13% of women
report postpartum depression.15 There
are no data to demonstrate that exercise
during pregnancy reduces the risk of post-
partum depression. There is, however,
evidence to suggest that exercise can be
used as an effective adjunctive therapy to
treat postpartum depression.16
The Impact of Postpartum
Exercise on Breastfeeding
Exercise and lactation are both energy-
demanding physiological processes. Wom-
en who breastfeed often have concerns
that exercise could adversely affect their
breast milk and impact their infants’
growth. Studies in both animals and
humans, however, provide evidence that
exercise typically does not have a detri-
mental effect on milk volume and
composition or infant growth and devel-
opment.17
Women lose water through sweating
when they exercise and burn approxi-
mately 300 to 600 kcal/hour.5 Both of
these factors could theoretically impact
the milk produced. Studies show that
regular exercise at moderate to high in-
tensity does not alter the quality or
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Exercise and Lactation 887
quantity of breast milk. Anaerobic exer-
cise that is extremely intense, however,
may alter the taste of milk due to by-
products such as lactic acid and thus
impact nursing behavior.17
Participating in postpartum exercise
typically does not affect the growth of
infants in terms of weight and length as
long as a few parameters are met. It is
important to remember that each woman
is different, as are her breastfeeding prac-
tices. These values are not exact, rather
guidelines, and may vary slightly from
woman to woman. First, studies suggest
that caloric intake should not fall well
below caloric expenditure (calories in
should not be below 20% to 25% calories
out). Second, women should eat at least
1500 kcal/day and lastly, weight loss
should be no more than three quarters
to a pound per week. Women who stray
far from these recommendations seem to
be at greater risk for a decrease in milk
production and decreased weight gain in
their infants.5,17 One of the best indicators
that exercise and breastfeeding are work-
ing well together is that the baby seems
content and growth is normal.
Exercise Recommendations
The postpartum period is an amazing, yet
daunting time. Patients have just given
birth and are going home to a completely
different family dynamic. They are eager
to lose weight and ‘‘get back in shape,’’
but are often overwhelmed with the time it
takes to care for a newborn, as well as a
level of fatigue and responsibility that
cannot be understood until experienced.
Exercise and physical activity can play a
vital role in health and well-being during
this time. Exercise should be a time of
enjoyment, relaxation, and provide a
break from taking care of the baby. In
addition, it should be one of many ways in
which a woman focuses on her own health
during this major time of transition in her
life.
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888 Bane
It is important to remember that wom-
en are caregivers. They often nurture
everyone else in their lives except them-
selves. The postpartum period is a great
time to remind them that they can care for
others best when they also take great care
of themselves. Healthy selfishness is a
psychological construct that is a way of
thinking and acting in which there is a
deep appreciation, compassion, and con-
cern for yourself by yourself.18 Sharing
this concept reminds patients that it is
important to think and care for them-
selves. Taking time away from the baby
to exercise, go out to lunch, or simply
asking for help from others is not only
important, but should not be associated
with feelings of guilt.
There are several resources available
that provide guidelines for exercise during
the postpartum period in women.5,19,20
Many women who breastfeed have ques-
tions about starting exercise after they
deliver and the safety of it for their baby.
This section provides guidelines that not
only reassure the patients, but also clini-
cians. Exercise is an important health
behavior that should be encouraged for
most postpartum patients. A summary of
practical recommendations for postpar-
tum exercise in women who are breast-
feeding are provided below
Gradual Start
Many of the physiological changes of
pregnancy persist for 4 to 6 weeks post-
partum. Thus, exercise must be intro-
duced gradually and will depend on
several factors, including prepregnancy
and pregnancy activity level, as well as
the mode and ease of delivery. Clinicians
often recommend women walk the halls
of the hospital the day after a cesarean
section. Most women are able to resume
activities quickly after delivery without
harmful effects. Others who have had a
cesarean section or laceration repair will
have to start more slowly. Regardless, all
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women exercising during the postpartum
period should be encouraged to listen to
their body and stop or modify their exer-
cise if they are having heavy bleeding,
pain, or do not feel comfortable with the
activity.
Hydration
Women sweat and burn calories when
they exercise for a sustained period. While
they will typically increase their calories
spontaneously, they often do not drink
enough fluids, putting them at risk for a
reduction in milk volume. Encourage
women to drink fluids regularly through-
out the day. There is no set number of
recommended ounces to drink. A good
gauge of hydration is the color of urine.
Educate patients that clearer urine means
better hydration. Darker yellow urine
would signal them to drink more.
Support of Breasts
Breasts increase in size and mobility dur-
ing pregnancy and this occurs even more
with breastfeeding. The breasts need sup-
port and stabilization during postpartum
exercise. Women may need to wear 2 bras
or even consider using an ace bandage
crisscrossed over the chest and shoulders
to compress the breasts against the chest
wall and reduce discomfort. Cotton or
silk bras that are made of a smooth fabric
should be worn to reduce the risk of nipple
abrasion. Encourage timing exercise so
that a woman breastfeeds before being
active reduces the weight of the breast
and makes exercise more comfortable.
Exercise Prescription
An exercise prescription is a specific plan
of fitness-related activities that are de-
signed to accomplish a specific purpose.20
Clinicians use a prescription pad to detail
what medication a patient should take,
how much should be taken, and how
 Exercise and Lactation 889

TABLE 3. 2008 Physical Activity down into 3 areas to clearly explain this:
Guidelines for Americans for (1) general guidelines for physical activity
Adults for women during the postpartum period,
General Aerobic Muscle (2) the practical application of these
Recommendations Activity Strengthening guidelines during the first 6 weeks after
delivery in women who are breastfeeding,
All adults should At least Include all the
avoid inactivity 150 min or major muscle and (3) application of these guidelines
2½ h per groups after the first 6 weeks.
week of
moderate GENERAL PHYSICAL ACTIVITY
intensity GUIDELINES
activity
(brisk
The US Department of Health and Hu-
walking) man Services provides recommendations
OR for physical activity in its 2008 Physical
Some activity is At least 2 or more days Activity Guidelines for Americans.2 Key
better than none 75 min of per week elements for adults can be found
vigorous
intensity
in Table 3. It is important to note that
activity both aerobic and muscle-strengthening
(running) exercises are recommended. Aerobic ex-
per week ercise improves cardiorespiratory endur-
OR ance and involves the heart and lungs
Some health Any Examples
benefits occur combina- include
delivering oxygen to skeletal muscle to
with any tion of weight lifting, perform work. Examples of aerobic exer-
amount of moderate pilates, yoga, cise include walking, running, swimming,
activity and resistance cycling, or aerobics class. Muscle-
vigorous bands strengthening exercises improve muscular
activity per
week
fitness and this refers to how skeletal
Substantial health Aerobic Stretching muscles contract to allow work such as
benefits occur activity exercises pushing, pulling, or holding objects. Ex-
with increased should be in should also amples of exercises that improve muscle
aerobic activity bouts of at be performed strength include free weights, pushups,
and this is dose least 10 min when doing
dependent and spread strengthening
curl ups, resistance bands, and yoga. Dur-
(more throughout ing the postpartum period, these recom-
activity = more the week mendations apply to patients given they
health benefits) remain healthy, adapt activity to their
particular postpartum recovery experi-
ence, and discuss any concerns with their
often. An exercise prescription does the health care providers.20
same. It tells a patient what type of exer-
cise to do, how often to do it, for how THE FIRST 6 WEEKS
long, and at what intensity. An exercise The goals of exercise during the first 6
prescription will be different in the first 6 weeks postpartum are to promote healing,
weeks after pregnancy compared with help with weight loss, and provide a break
weeks and months later because of the from the baby. Walking is the most com-
healing and repair that happens in the first mon form of aerobic exercise women typ-
weeks after delivery. Because of these ically do in the first 6 weeks after delivery.
differences, clinicians should focus on Walking can be done in the hallways of the
different goals and outcomes for each house and moved to the street, neighbor-
time period. This section will be broken hood, mall, or fitness center as endurance

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890 Bane

TABLE 4. Handout: Strategies and Guidelines to Patients

Breastfeeding and postpartum exercise
The postpartum period can be one of the most gratifying and exhausting times in a woman’s life. The joy
of motherhood is mixed with the reality of interrupted sleep, recovering from delivery, and unfamiliarity
of caring for a baby. It is important to focus on your own health while breastfeeding and caring for your
newborn. Exercise is a simple and inexpensive intervention that can play a significant role in maximizing
health and wellness during the postpartum period and beyond. Exercise and breastfeeding are safe.
Exercise typically does not have a detrimental effect on milk volume and composition or infant growth
and development
Breastfeeding and exercise tips
Start gradually and slowly. Listen to your body. Stop or modify exercise if you are having heavy bleeding,
pain, or it just does not feel right
Stay hydrated. Exercise causes fluid loss through sweating. Drink at regular intervals throughout the day.
Dark yellow urine is a sign of dehydration and you should drink water until your urine is clear
Think support of breasts. Breastfeed before exercise to reduce the heaviness of the breasts. Sometimes, 2
bras are needed to provide support and stability. An ace bandage crisscrossed over the shoulders and
chest can add additional support
Weight loss should be no more than three quarters to a pound per week. Be patient
Eat at least 1500 kcal/d. Caloric intake should not fall well below caloric expenditure (calories should not
be below 20%-25% calories out)
Walking is a good choice for exercise to start with and can be increased in intensity, frequency, and
duration as tolerated. Jog strollers are great for both you and the baby. They provide a smooth ride for
the baby because of large wheels. The high handle bars allow for natural walking posture
As you become stronger during the first 6 wk, you can add other types of activities. Biking can be
performed if you do not have a laceration repair that would be aggravated. Swimming can be
recommended once bleeding stops and repairs are healed. Women can also participate in exercise classes
such as yoga, zumba, and aerobics during the postpartum period if tolerated. Many fitness centers have
‘‘Mommy and me’’ classes in which you can bring your baby
After the first 6 wk, exercise intensity, duration, and frequency can continue to increase as tolerated.
Extremely vigorous exercise may alter the taste of milk due to lactic acid and thus impact nursing
behavior. If your baby does not want to nurse after exercise, reduce intensity of exercise
Use common sense when exercising. Breastfeeding and exercise can be very compatible. A content baby
that is growing and developing normally is an excellent indicator that exercise and breastfeeding are
working well together for both mom and baby

and strength increase. If a woman does not
have someone to watch the baby, jog
strollers are a great way to include the
baby in the activity. These strollers pro-
vide a smooth ride for the baby because of
large wheels. The high handle bars allow
for natural walking posture.
As women become stronger during the
first 6 weeks, they can often add other
types of activities. Biking can be per-
formed if the patient does not have a
laceration repair that would be aggra-
vated. Swimming can be recommended
once bleeding stops and repairs are
healed. Women can also participate in
exercise classes such as yoga, zumba,
and aerobics during the postpartum peri-
od. Many fitness centers and exercise
programs geared for the postpartum peri-
od that incorporate the baby in the class.
Most importantly, women need to lis-
ten to their bodies and start gradually
increasing their activities. They should be
encouraged to be patient, modifying dif-
ferent elements of the class to make sure
that they are not experiencing pain. Some
women who were active before and during
pregnancy may even meet the guidelines
for aerobic and muscle strengthening pro-
vided in Table 3 during these first weeks. It
is important to remind them to focus on
healing during the immediate weeks after
delivery and that it will often be a few
months before they can participate in ex-
ercise at a frequency and intensity that
they were before their pregnancy.

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BEYOND 6 WEEKS
Most of the physiological changes of
pregnancy will be complete within 6 weeks
postpartum. If the delivery was not par-
ticularly complicated, many women can
exercise at a frequency and intensity
to meet physical activities guidelines
in Table 3. As exercise levels increase,
women who are breastfeeding need to be
particularly mindful of staying well hy-
drated (clear urine), watch caloric intake
to make sure they are not >25% below
calories expended, and keep weight loss to
three quarters to a pound/week. Other
helpful tips for breastfeeding women
who are exercising at higher intensity in-
clude nursing before a vigorous workout
to reduce breast size and discomfort dur-
ing activities that require jumping or
quick movements. In addition, extremely
vigorous exercise can be associated with
an increase in lactic acid in breast milk. If
the baby is reluctant to breastfeed after
vigorous exercise, it may be due to a
change in taste in the milk due to by-
products such as lactic acid. Suggest re-
ducing exercise intensity so that lactic acid
is not significantly produced and the baby
successfully nurses.
Breastfeeding and exercise are a great
combination for both mother and baby.
Clinicians should promote exercise to the
majority of women during the postpar-
tum period. Contraindications are few
and include heavy bleeding, pain, and
infection.5 Providing simple strategies
and guidelines to patients such as the
handout (Table 4) helps reassure pregnant
patients that breastfeeding and exercise
are safe and compatible.
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