5 ways to avoid diastasis recti during pregnancy

Think a postpartum pooch is par for the course? Think again.

When I was pregnant with my first baby, I was certain I would snap back to my prebaby self come postpartum. After all, I had been a lifelong athlete and maintained a healthy and active pregnancy.

But there I was—months postpartum—not feeling like myself at all. Even though I was down to my prepregnancy weight, I still had a belly pooch and my stomach muscles were so weak that I could hardly get out of bed. Was this just the new normal after baby? Would I ever be able to do heavy lifting at CrossFit again? Or even find the core strength to do a push up?

After doing some research, I discovered what I was experiencing was not normal. My weak abs and protruding tummy were a symptom of abdominal muscle separation known as diastasis recti. Diastasis recti is a common condition that happens when the connective tissue that holds together your rectus abdominis muscles (aka your six-pack muscles) separates. This separation is not painful, but it can lead to many undesirable side effects, including abdominal weakness, belly pooching, back pain (especially lower back pain) and urinary incontinence—symptoms women have come to accept as normal parts of the postpartum body.

But these things aren’t normal. According to Becca Sanders Fung, DPT, who’s certified in prenatal and postpartum physical therapy, “Many women have been told that it is normal to have a pooch around their midsection or even incontinence when you laugh or run after baby. Although these things are common, they are not normal and are signs of an underlying dysfunction.” Studies show diastasis recti affects up to 80 percent of postpartum women, but the majority never know they have it. Because diastasis recti itself is painless, most women assume the belly pooch and weakness are normal parts of their mama physique.

A lack of information, however, could lead them to unknowingly make the separation worse instead of better. “Traditional abdominal exercises, like crunches and sit-ups, usually won’t make your abs flat if you have diastasis recti,” explains Fung. “Without the proper progression back to strength, they can make the abdominal separation worse by putting pressure on your abdominal connection.”

For me, my new and unfamiliar shape left me feeling confused and frozen, unsure of what would strengthen my abs and what would make the separation worse. But Fung assured me all hope was not lost.

“Women can definitely get stronger abs and bodies after baby. This can also help them have more confidence in their daily activities—whether it’s running or lifting their kids,” says Fung. With proper strengthening exercises, good body mechanics and abstaining from activities and exercises that put pressure on the separation, women are able to heal their abs and get back to their favorite prebaby activities.

Upon completing the program that Fung designed and healing my abdominal separation, I began to feel like my old self—just in time to become pregnant once more.

Two years later, I’m expecting my second baby. Although I know I am likely to develop diastasis recti again, I will be approaching this pregnancy differently and doing everything I can to strengthen my core before baby arrives. As Fung says, “We know that women who are stronger during their pregnancy usually have better results in the postnatal period.”

Here are five things I’m going to do this time to save my abs while pregnant:

1. Avoid crunches

Crunches are one of the most popular abdominal exercises, but they are best avoided by pregnant women. Crunching or piking puts pressure on the linea alba—the connective tissue that holds your abdominal muscles together. This tissue is already under stress from the 40 weeks of growing baby, and extra stress can increase the chance of tearing the tissue and developing diastasis recti.

2. Strengthen deep core and gluteal muscles

Just because I’ll be avoiding crunches does not mean I’ll completely ignore my core. Rather, I’ll be focusing on the deep core muscles, such as the transverse abdominis and pelvic floor. The transverse abdominis acts as a corset by supporting the core and reducing stress on the abdominal connection. Strengthening gluteal muscles adds support outside the pelvis, too. (Bonus: Working these muscle groups has been shown to help with labor and delivery.)

3. Roll out of bed

I am so used to sitting up to get out of bed that I continued with this exit strategy through my first pregnancy. I’d even notice a bulge in my belly when I crunched up (which I now know was a sign of a developing abdominal separation). This time around, I’ll roll to my side, then push with my arms to get out of bed. Even though it seems like a small change, the modification goes a long way toward reducing stress on your abs.

4. Use active posture

We have all witnessed the “pregnant waddle,” with the hand on the back and the belly button protruding forward. This posture actually puts extra strain on your abs by pushing your belly forward. A better way to stand is with active posture, making sure your shoulders are back and your head, spine, and pelvis are aligned.

5. Commit to a rehab program

As much as we don’t like to admit it, labor and delivery causes trauma to the body, and we need to recover in a focused and directed way—just like we do with other injuries under the care of a physical therapist. I plan to use the Abs After Baby program (abs-after-baby.com), which I co-founded with Fung, to strengthen my postpartum ab muscles. I’d encourage you to find a similar exercise program specializing in postpartum recovery that you can trust and commit to it.

But what about C-section deliveries?

Regardless of how baby is brought into the world, diastasis recti is a risk factor for pregnant women. However, during a C-section, your muscles are stretched further apart than normal. This is because during surgery, doctors usually separate the muscles along the abdominal wall to access the baby versus cutting through the muscle, thus creating more separation. There are different schools of thought in stitching the abdominal muscles back together or allowing them to heal on their own (and sometimes it depends solely on your personal autonomy). Either way, cesarean mommies can expect to have some degree of diastasis recti after birth and can benefit from the same practices listed above.

It is important to let your body heal for a minimum of six weeks after surgery (some moms need upward of 12 weeks) and discuss a safe and appropriate recovery plan with your healthcare provider or OB-GYN.

Too many women are unhappy in their postpartum bodies, specifically their midline area. They feel embarrassed, ashamed and hopeless that there is no solution for them. I know because I was one of them. But this pregnancy I feel empowered. I know that the right combination of physical therapy and strengthening exercises can help me recover from pregnancy.

It’s never too late to heal your body or your diastasis recti. Whether you are six months, six years or even 16 years postpartum, there is a way to train your body and abdominal muscles to be strong again. If a professional athlete had sprained his ankle, we would not expect him to limp forever. When moms have a baby, they should not expect to have a belly pooch forever. Both simply require the proper therapy, guidance and exercise—and both can heal.

Tip: How to tell if you have diastasis recti:

This quick trick can be done after both cesarean and vaginal deliveries to determine whether or not you’re experiencing abdominal separation.

Lie on your back with your knees bent and your feel flat on the floor. Gently bring your head up into a crunch-like position (keeping shoulders on the floor) and use your finger tips to check and see if there is a separation. Depending on your finger widths (two, three or more) will determine how wide the separation is.

Good to know: Though often confused, diastasis recti is different from a hernia, and both require different treatments. While diastasis recti is signified by separation of abdominal muscles, the fascia of the wall (the connective tissue beneath the skin) stays in tact. With a hernia, an actual hole or defect forms in the fascia and requires surgery for full closure.

By Monica Burrell

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