Pilates guide
Postnatal (postpartum) Pilates is a gentle way to rebuild strength after having a baby, and you don't have to wait for your 6-week check to start. Breathing, pelvic floor exercises and short walks can begin in the first days, and UK pelvic health physiotherapists say gentle Pilates is safe from about 4 weeks if you have no bleeding, wound or pelvic floor problems. After a caesarean, go by comfort: it may take 6 weeks or so. The Pilates trials after birth are few and small, so this guide says plainly what they can and can't show.
Pilates sits beside your midwife, health visitor, GP and, if you need one, a pelvic health physiotherapist, not in place of them. This guide sets out the stages from the first days to about 3 months, what to do about leaking and a tummy gap, what the trials show for sleep, tiredness, mood and back pain, mat or reformer, and the warning signs to stop. It ends with a 20-minute postnatal class with 3D demos.
After a straightforward birth, the NHS says you can start gentle exercise, such as walking, gentle stretches and pelvic floor exercises, as soon as you feel up to it. UK pelvic health physiotherapists say breathing and pelvic floor exercises can start within the first few hours, or once your catheter is out after a caesarean.
The UK pelvic health physiotherapists' Pilates booklet (past its review date) says gentle Pilates is safe from 4 weeks if you have no concerns about bleeding, wound healing or your pelvic floor. No trial has tested start times. A full beginner class suits from about 6 to 8 weeks, and harder exercise builds up over at least 3 months after your check.
The UK guidelines say to start pelvic floor exercises as soon as you can and keep them up daily. Started after birth, pelvic floor training cut the odds of leaking by 37% in a 2025 review. Pilates uses your pelvic floor, but it doesn't replace these exercises.
In 300 first-time mothers, a gap was found in 60% at 6 weeks and a third at a year. Exercise narrows it a little, about 4 to 8 mm on average, and curl-ups didn't widen it in a trial.
In 80 women, home Pilates from 3 days after the birth improved sleep and tiredness, and in 60 women, online Pilates in pregnancy and after birth lowered depression and back pain scores. Across 29 trials, being active after birth eased low mood and anxiety. Pilates trials after birth are small, so treat the details as promising rather than proven.
Bleeding that gets heavier or comes back, a red or oozing wound, a swollen leg, chest pain or breathlessness, and thoughts of harming yourself or your baby all need help, some of them urgently. The warning signs below give the details.
Postnatal Pilates starts with Pilates breathing, then adds the pelvic floor and the deepest tummy muscle to simple moves on your back, side and hands and knees. UK pelvic health physiotherapists say Pilates-based exercises "encourage the pelvic floor muscles to work with the deep tummy muscles to build up the strength of your trunk".
The cue is the same in every move: breathe out, gently squeeze your pelvic floor and draw your lower tummy in and wide, move, then let everything go fully before the next one. Your tummy "should not bulge upwards or dome"; if it does, make the move easier.
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The tummy wall stretches and the two long muscles down the middle can separate (a tummy gap). The pelvic floor is stretched by pregnancy and by a vaginal birth: about a third of women have some leaking after birth. Leaking is less common after a caesarean (up to 1 in 5) than after a vaginal birth (up to 1 in 2), but a caesarean is major surgery, with more pain and a slower recovery.
The NHS suggests postnatal exercises at home or a postnatal class, where you can often bring your baby, and asks you to tell the teacher if a class isn't a postnatal one. Your health visitor may know of local classes.
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See a pelvic health physiotherapist before Pilates if you have a diagnosed tummy gap, leaking, heaviness or a bulge, or concerns about bleeding or wound healing. Canada's 2025 guideline lists severe tummy pain, bleeding that isn't a period, heart symptoms, unstable blood pressure and calf pain or swelling among the reasons to talk to a doctor before harder exercise.
No trial has compared start times, so these stages come from health services and pelvic health physiotherapists: go by how you feel, not the calendar.
Breathing, pelvic floor squeezes, a side-lying tummy draw-in and short walks. ACOG, the American obstetricians' college, says some women can be active again within days, and pelvic floor exercises can start straight after the birth.
UK pelvic health physiotherapists suggest a pelvic tilt held for 3 seconds, knee rolls, heel slides and a head lift, building up to 10 repetitions 3 times a day. Then knee lifts, knee fall-outs and bridges, 2 sets of 5 to 10, every other day. Their Pilates booklet says gentle Pilates is safe from 4 weeks if you have no bleeding, wound or pelvic floor concerns.
A beginner class or our postnatal class suits once the early moves feel easy, with no doming, leaking or heaviness. The 6 to 8 week check is the time to ask about high-impact exercise such as running. Strength work for lifting (squats, bridges and a light hinge, no heavier than your baby in a car seat at first) fits here too.
The UK guidelines say harder exercise can build "from moderate to vigorous over a minimum period of at least 3 months" after your check, and vigorous activity "is not recommended for previously inactive women". The return-to-running guideline advises against running before about 3 months. Aim for 150 minutes of moderate activity a week, with muscle-strengthening on 2 days.
Across 18 guidelines, the advice is at least 120 to 150 minutes of moderate activity a week after birth, plus pelvic floor and strengthening exercise. Canada's 2025 guideline suggests building up gradually once wounds or tears have healed and bleeding doesn't increase with activity.
The NHS says to start exercising again when you feel able to and it isn't uncomfortable: "This may not be for 6 weeks or so." The Royal College of Obstetricians and Gynaecologists says recovery usually takes about 6 weeks, and 1 in 10 women have discomfort for the first few months.
Daily walks lower the risk of blood clots. Start breathing and pelvic floor exercises once your catheter is out: the pregnancy itself loads your pelvic floor, so they matter after a caesarean too.
UK pelvic health physiotherapists say to lift nothing heavier than your baby for at least 6 weeks, avoid activities that strain for the first few weeks, and support your wound with your hands or a pillow when you cough or laugh.
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Start the lying and side-lying moves when your wound is comfortable. Leave head lifts and curl-ups until lifting your head or a leg doesn't pull on the scar, and planks and loaded twists until later still (our reading of the guidance; no trial has tested timings after a caesarean). Gentle scar massage is suggested from about 6 to 8 weeks.
The UK guidelines: "Start pelvic floor exercises as soon as you can and continue daily." NICE asks midwives, health visitors and GPs to talk about pelvic floor exercises at every postnatal contact.
In a 2025 review of 65 studies, pelvic floor training after birth cut the odds of leaking by 37% (7 trials, 1,930 women; moderate certainty) and of prolapse by 56% (1 trial). The Cochrane review is more cautious about offering it to everyone after birth: the benefit was clearest for training started in pregnancy. In a 2026 analysis of 19 studies, leaking eased during pelvic floor training, but not significantly more than in comparison groups.
NICE suggests a supervised 3-month programme after a forceps or ventouse birth, a birth with your baby facing up, or a tear involving the anal sphincter. With pelvic floor symptoms, it says supervised exercise such as yoga "may help" alongside supervised training.
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In small laboratory studies, a crunch widened the pelvic floor opening, while bird dog, plank and leg lifts acted much like a pelvic floor squeeze, and tightening the pelvic floor first reduced how far the bladder dropped during exercises. These are single small studies: use them as a reason to make a move easier if it brings on leaking or heaviness, not to ban moves.
From the NHS's post-pregnancy body page. If you can't feel a squeeze, or you leak or feel heaviness, see a GP or pelvic health physiotherapist.
See the movement on the 3D figure: Pelvic floor exercise (Kegel)
In 300 first-time mothers, a gap was found in 33% at 21 weeks of pregnancy, 60% at 6 weeks after birth, 45% at 6 months and 33% at a year, and back and pelvic pain was no different with or without one. The NHS says to contact a GP if the gap is still obvious 8 weeks after the birth.
In 6 trials, tummy exercise narrowed the gap by about 4 mm (moderate certainty), judged too small to matter. In 9 trials of 450 women, it narrowed it by about 8 mm, more when started within 3 months, but disability scores were no different. Other reviews rate the evidence low to very low.
In 35 first-time mothers 2 to 12 months after birth, 4 weeks of Pilates (50 minutes, 5 days a week) narrowed the gap by 3 to 7 mm against 1 to 2 mm without it, and trimmed waist size by about 3 cm. It wasn't randomised, and most gaps were under 2 cm at the start. A network meta-analysis ranked Pilates highly for the gap at the belly button, from indirect comparisons.
In a trial of 70 women 6 to 12 months after birth with a gap, head lifts and curl-ups 5 days a week for 12 weeks didn't widen it and built strength. ACOG says tummy strengthening, including crunches, can reduce the gap; the NHS advises avoiding sit-ups and planks to start with. Drawing your lower tummy in before a curl-up changed how the midline behaved in a small study, but nobody knows yet whether that matters.
These are few, small trials, several from one country, at moderate to high risk of bias. They point the same way, but the size of the benefit is uncertain.
In 80 first-time mothers, home Pilates started 72 hours after the birth (30 minutes, 5 times a week for 8 weeks) improved sleep quality scores and all kinds of tiredness scores against no exercise; sleep duration didn't change. Same trial, two reports. Reviews of exercise around birth find benefits for sleep and tiredness too, with a lot of variation between trials.
In 60 women, live online Pilates twice a week (8 weeks in pregnancy, then 8 weeks after birth) lowered postnatal depression, stress and back pain scores against no exercise. An uncontrolled online study suggested about 150 minutes a week after birth went with the biggest improvements in back pain, sleep and mood.
Across 29 trials and 3,915 women, being active after birth eased depressive symptoms and anxiety by a moderate amount and improved quality of life, with mind-body and multicomponent activities doing best and benefits peaking at moderate weekly amounts. An umbrella review rated the effect on depression moderate certainty. Activity helps alongside support and treatment, not instead of it.
In 37 trials of 1,739 women, stabilisation exercise (the family Pilates belongs to) eased low back and pelvic pain after birth in the short term, though results varied a lot between trials.
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In one trial of 74 breastfeeding women with a forward head posture, 8 weeks of Pilates plus advice on feeding positions eased neck pain, neck disability and tiredness more than advice alone. It's a single trial with unusually large effects, so treat it as promising.
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In 42 women, keeping up a pregnancy Pilates programme until the birth went with looser joints settling faster, less pelvic girdle pain and more daily steps at 6 weeks after birth.
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We found no trial of reformer Pilates after birth, and none comparing when to start Pilates after a vaginal birth or a caesarean.
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First weeks: breathing, pelvic floor and the basic tummy exercises, up to 10 of each, up to 3 times a day. From about 4 to 6 weeks: our 20-minute postnatal class 2 or 3 times a week, with daily walks and pelvic floor exercises (our editorial starting point; the sleep trial used 30 minutes at home 5 times a week). The UK guidelines ask for muscle-strengthening on 2 days a week.
No trial has tested the reformer after birth. Classes can be gentle, but many include planks, kneeling work and jumping, which the NHS suggests avoiding to start with. Start with a mat or postnatal class, and tell any teacher how and when you gave birth (our suggestion).
"You can be active while breastfeeding." Regular exercise doesn't change how much milk you make or your baby's growth, ACOG says, and the NHS says a brisk daily walk "will not affect the quality or quantity of your breast milk". Feed or express first if your breasts feel full.
Lateral breathing, 5 to 8 breaths (the move's page). Pelvic floor exercises, 8 slow holds of up to 10 seconds and 8 quick squeezes, 3 times a day, building to 10 (the move's page). Pelvic floor relaxation, 5 to 10 slow breaths (the move's page). Side-lying tummy draw-in, up to 10 holds of 10 seconds (the move's page, the NHS's dose).
The UK pelvic health physiotherapists' basic exercises: pelvic tilts held 3 seconds, heel slides and knee rolls, up to 10 each (their Fit for the future booklet's dose); knee folds and knee fall-outs, 2 sets of 5 to 10 every other day (the same booklet's dose, as on those moves' pages). Head lift only at first in the chest lift; the full chest lift from about 6 weeks, 8 reps (our beginner class).
Clamshells, 10 each side with a pillow between your knees (our postnatal exercises routine); side-lying leg raises, 8 each side (our beginner class).
Cat-cow, 6 to 8 slow reps in a small range (our postnatal exercises routine); bird dog one limb at a time, 5 each arm and leg, with your knees padded (our neck pain class).
Thoracic rotation, 6 each side with the breath, and the side-lying open book, 8 to 10 slow openings each side (the moves' pages); chin tucks, 8 slow reps held 3 to 5 seconds (our posture class).
Sit to stand, 8 to 10 reps, breathing out and squeezing as you stand (our postnatal exercises routine); hip-hinge practice, 8 slow reps, as when lifting the car seat (our editorial starting point); wall push-ups, 2 sets of 10 (our diabetes class).
The NHS suggests avoiding sit-ups, planks and high-impact exercise to start with. Leave the hundred with your head up, the roll-up, double-leg stretch, teaser, planks, jumping and running for the first 6 to 12 weeks, then build up if there's no doming, leaking or heaviness. Curl-ups themselves are fine later.
After having a baby, if your tummy bulges upwards or domes during this move, draw your lower tummy in and wide or use an easier version, such as keeping your head down, as the UK pelvic health physiotherapists' (POGP) Pilates booklet advises; if it keeps happening, see a pelvic health physiotherapist.
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Start knee folds once lifting a leg doesn't pull on the wound, move knee fall-outs within comfort, and roll onto your side to get up from the floor.
Make the move smaller, skip jumping and running, keep up your pelvic floor exercises, and see a GP or pelvic health physiotherapist.
Lying face down can be uncomfortable when your breasts are full or tender; do back-strengthening moves on your hands and knees instead (our suggestion).
Our 20-minute postnatal Pilates class takes you from the first-weeks basics to a full beginner class, with a stop point for the early weeks. The postnatal exercises routine is for the first days and weeks; the postnatal strength workout adds weights from about 6 weeks; the pelvic floor class and daily routine train the pelvic floor; and the beginner class suits from about 8 to 12 weeks.
A 20-minute postnatal Pilates class: breathing and pelvic floor, lying, side-lying and hands-and-knees moves, upper back work for feeding and a standing lift.
20 minBeginner16 movesA bench or boxA gentle 25-minute routine for the first weeks after birth: pelvic floor, breathing, tummy and hip exercises on the floor, sit-to-stands and a walk.
25 minBeginner12 movesA bench or box, Cardio machineA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentA 20-minute Pilates workout for your pelvic floor, built on UK pelvic health physiotherapists' booklet: squeeze as you breathe out, move, then fully release.
20 minBeginner18 movesA wall, A bench or boxA 25-minute strength workout from about 6 weeks after birth: sit-to-stands, deadlift practice, push-ups, rows, bridges and tummy work, with the knack.
25 minBeginner14 movesA bench or box, A kettlebellA 12-minute tummy routine copied from a trial in women with diastasis recti: head lifts, curl-ups and twisted curl-ups, 5 days a week for 12 weeks.
12 minBeginner5 movesNo equipmentA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentThe postpartum plan runs week by week from the first days, with a caesarean track; the 4-week beginner Pilates plan suits from about 8 weeks, once our class feels easy.
A postpartum workout plan from the first days after birth to running and lifting again, week by week, with a caesarean track and readiness checks.
5 training days25 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginnerThese match our guide to exercise after birth. In the US, call 911 where this page says 999.
Call 999 or go to A&E if it feels like an emergency:
Stop exercising and get advice for:
Pre-eclampsia can start after the birth, most often within 48 hours, and the risk lasts for up to 6 weeks. The risk of a blood clot is higher in the 6 weeks after having a baby: the NHS says to call 999 or go to A&E if you have pain and swelling in a leg and feel short of breath or have chest pain. In the US, call 911 or go to an emergency room for sudden breathlessness or chest pain, which can be signs of a blood clot in the lung.
Contact your midwife or GP straight away if you have:
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Thoughts of harming yourself or your baby: the NHS says to call 999 or go to A&E if your life is at risk or you can't keep yourself safe, and for urgent help to call 111 and choose the mental health option, or ask for an urgent GP appointment. You can also call Samaritans on 116 123. In the US, call or text 988.
If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.
If you think you might have postnatal depression, speak to your GP, midwife or health visitor; you can also refer yourself to NHS Talking Therapies.
See your GP, health visitor or a pelvic health physiotherapist if you have:
If your bleeding turns red again, gets heavier or restarts after exercise, you've probably done too much. Drop back, and tell your midwife if it continues. This rule is ours, built from the Canadian and NICE guidance.
Call 999 if:
Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.
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The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
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After a straightforward birth you can start gentle exercise as soon as you feel up to it; the check is about high-impact exercise such as running. Breathing and pelvic floor exercises can start within hours, and gentle Pilates from about 4 weeks.
Neither. Exercise narrows the gap only a little, and curl-ups didn't widen it in a trial while building strength. The NHS's advice is to avoid sit-ups and planks to start with, then build up.
It's common, but it's treatable: pelvic floor training cuts the odds, and NICE offers supervised training. See your GP or a pelvic health physiotherapist.
One small, non-randomised study found a waist about 3 cm smaller after 4 weeks of Pilates. Bodies change over months after a birth, and the trials show benefits for strength, sleep and mood more reliably than for shape.
Pregnancy itself loads your pelvic floor, and up to 1 in 5 women leak after a caesarean. Do them after any birth.
No trial has tested the reformer after birth, and classes often include planks and kneeling. Start with a mat or postnatal class.
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Breathing, pelvic floor exercises and short walks can start in the first days after a straightforward birth, and gentle Pilates from about 4 weeks if you have no bleeding, wound or pelvic floor problems. A full beginner class suits from about 6 to 8 weeks, and harder classes from about 3 months. Go by how you feel, not the calendar.
Start breathing and pelvic floor exercises once your catheter is out, and walk every day. Exercise may not feel comfortable for 6 weeks or so, so begin the gentle lying and side-lying moves when your wound is comfortable, and lift nothing heavier than your baby for at least 6 weeks. Leave curl-ups until lifting your head doesn't pull on the scar.
Yes, gentle Pilates: UK pelvic health physiotherapists say it's safe from 4 weeks without bleeding, wound or pelvic floor concerns. The check is the time to ask about high-impact exercise such as running.
It's a good fit: it trains the pelvic floor and deep tummy muscles together, it's low-impact, and you can do it at home. Small trials found better sleep, less tiredness and lower depression and back pain scores, and being active after birth helps mood in larger reviews. It works best alongside daily pelvic floor exercises and walking.
It may narrow it a little: exercise narrows the gap by about 4 to 8 mm on average, and one small Pilates study found a few millimetres in 4 weeks. Most gaps shrink on their own over the first year. If it's still obvious at 8 weeks, see your GP or a pelvic health physiotherapist.
Not straight away: the NHS advises avoiding sit-ups and planks to start with. Head lifts come first; later, curl-ups are fine, and in a trial they built strength without widening the gap. Keep your head down in the hundred until your tummy no longer domes.
Doming is a sign to make the move easier: draw your lower tummy in and wide, or keep your head down. Leaking, heaviness or a bulge means stopping that move and seeing a GP or pelvic health physiotherapist, as these problems are common and treatable.
Yes, once a mat or postnatal class feels comfortable, usually from about 6 to 12 weeks; no trial has tested the reformer after birth. Tell the teacher how and when you gave birth, and skip planks and jumping until you're ready.
Two or three short sessions a week, plus daily pelvic floor exercises and walks, is a sensible start. The trial that improved sleep and tiredness used 30 minutes at home, 5 times a week, for 8 weeks.
Yes: you can be active while breastfeeding, and exercise doesn't affect your milk. Feed or express first, wear a supportive bra, and use hands and knees instead of lying on your front if your breasts are tender.
Being active eases low mood and anxiety after birth in trials, and one small online Pilates trial lowered depression scores. It helps alongside support and treatment, not instead of it. Talk to your GP, midwife or health visitor, and get help straight away if you have thoughts of harming yourself or your baby.
Some NHS services and local groups run postnatal exercise or Pilates classes, and many let you bring your baby. Ask your midwife or health visitor what's near you. A class run by a pelvic health physiotherapist or a teacher trained in postnatal Pilates is ideal.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
