Everything you need to know about postnatal abdominal separation

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Our body is amazing in the way it changes to accommodate growing a baby and then the miraculous feat it takes to deliver a baby into the world!  Whether a mama delivers naturally or via c-section, we all have a body that’s changed.  I have always wanted to learn more about this topic and lucky for me, I have a friend Alana who happens to be a pilates instructor who shares a ton of information about what can happen to your core after having a baby.

What does a new mom need to be aware of after delivery?

New moms need to remember the following: You just had a baby. Your body had to physically change in order to do this. Please be kind and accepting to the fact that your “new” afterbirth body just did something amazing! Your body likely won’t be “the same” as it was before.

Postnatally we continue to produce relaxin, the hormone that allowed our body to become supple to accommodate our growing baby while pregnant. Relaxin can exist in the body up to one year, especially if you are breastfeeding. This means that our joints, ligaments, and muscular tissue are still more supple and therefore can be at risk of injury and/or hypermobility if you start working out too hard and too soon after delivery

Abdominal separation (or diastasis recti) during pregnancy is common and normal. However it becomes a concern if it doesn’t close by itself within 4-6 months and modifications to postnatal exercise must be made. Also it should be noted that the abdominals will be manually cut and separated when a baby is delivered by C-section (and stitched back together after baby is delivered).

Waiting 6 weeks after a vaginal delivery and 9-10 weeks after a c-section delivery until starting an exercise program is the ideal way to allow your core to heal to be ready to regain their strength.

How can women check for separation?

Your doctor or mid-wife should check you for a separation at your postnatal appointments but this doesn’t always happen.

If you have never been checked for a separation by your maternity care providers or you want to check yourself there are 3 things to look for when checking:

  • The width of the separation, measured by how many finger widths it is
  • How deep your fingers sink in. This depth is determined by the quality or elasticity of the linea alba. Early postpartum this tissue can feel very squishy! Almost like you’re sticking your finger into your guts! As time progresses and the deepest layer of the core muscles, the transverse abdominus, regains its strength, this tissue should become more elastic, rebounding your fingers back a bit as you push in
  • How long (above and below your belly button) your separation runs

How to check:

  • Lay on the floor with your knees bent, feet flat on the floor, head down
  • Curl your head and shoulders off the ground, gently feel above and below your belly button. You are trying to find the muscle border of the left and right rectus abdominus (the outermost layer of abs)
  • Measure how many fingers fit in between the muscles. Put your head back down for 30 seconds.
  • Curl up again- check above and below your belly button going down toward your pubic bone and up toward your rib cage

You’ll want to note how many fingers wide, deep (1 or 2 knuckles of your fingers sink in) and long (2 or 3 fingers below your belly button and 3 above) your separation is.  Write this and the date down to check your progress

 

(Photo provided by Alana showing DR pre & post Pilates exercises)

What do we need to know about Diastasis Recti (DR)?

First I want to explain a bit more about what physically happens to our bodies that can lead to DR.

When we are pregnant our pelvis tips forward and our lower back sways into a deeper extension to allow us to carry the baby’s growing weight. This position puts the abdominals in a lengthened, stretched, and potentially a strained position.

The muscles and fascia (connective tissue between our muscle fibres and organs) of our low back begins to tighten and the oblique abdominals and rectus abdominus pulls away from the linea alba (the center line of our abs above and below the belly button) and are drawn outward and back towards our spine.

Your abdominals may slowly move their way back to proper alignment on their own. However if they are not returning to their “correct position” you must realize that no matter how hard you try to strengthen them- if they are out of alignment they will not function properly.

Doing abdominal exercises during pregnancy and leaning forward (think being on an exercise spin bike) can strain the linea alba as these positions add extra pressure on the core. So modify your exercises! You can bring your handle bars closer and up higher to decrease the forward lean while biking. If you are in a class where they are doing pushups or planks, come down to your knees and up on your hands or even stand facing a wall and walk your feet back to do a vertical push up. There is no need to do crunches while pregnant. You should definitely still use your core and pelvic floor to support your baby while exercising but you want these muscles to be flexible not rigid!

There is really no known reason why some women separate and others do not. Super fit people with strong cores can separate and people who never exercised before or during pregnancy can separate too!

What do we do if we have DR? 

If you have DR you are probably also complaining of low back pain. This correlates to your compromised abdominals. If you have a weak core, your back is more susceptible to injury. If you are going to start exercising (walking, running, squats, biking) you need to try to engage your core or use an abdominal support band. If you use a belly band don’t rely on it solely for support but also use it as a reminder to engage your core. It is so important to note that the proper way to engage your core is not by flexing it like you’re about to take a blow to the stomach- instead you want to draw in your deepest core muscles towards your spine and lift your pelvic floor.

There are certain positions that are a no-go if you have DR.  This includes:

  • sit ups (core flexion against gravity causes pressure to be exerted in the core and with DR, your core cannot handle this pressure yet!)
  • Back extension- think upward dog in yoga or camel- this position also exerts too much pressure in the abdomen
  • Plank- a full version where you are on your toes and elbows or even hands will be too much pressure for your core at this time- you’ll need to modify

Stay tuned! My next blog will cover more on this topic, including what YOU can do to help with DR and the modification exercises!!!

Alana is a comprehensively trained Classical Pilates Instructor with two boys under four years old. When Alana was pregnant with her first son in 2014, she took the pre and postnatal pilates and diastasis recti recovery specialized training from the Centre of Woman’s Fitness by Carolyne Anthony.

 

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