Our bodies demonstrate profound resiliency in the childbearing year. After giving birth, your heart, lungs, circulatory system, uterus, endocrine system…everything, are coming back into balance. Your spinal alignment, pelvis, pelvic floor, and abdominal muscles also strengthen and realign after accommodating the growth of the uterus and your baby. For some women a stretching of the midline connective tissue between the rectus abdominal muscles may occur. This is known as Diastasis Recti or DRA. If you have a DRA, your body will need some special attention to support the rebounding process.
Risk and Outcomes
According to the Women’s Health Foundation, 60% of postpartum women will have some separation of the rectus abdominis muscles and 50% of those women will still have it three months postpartum. Women who have carried multiple infants, large babies, or have had pregnancies with polyhydramnios are at higher risk, as are women who are multiparas or have had prior cesarean births. Obesity is also a risk factor.
Without attention DRA can create overall core instability and, if unresolved over time, can lead to hernias, urinary incontinence, back pain, and further vulnerabilities related to the body’s overall alignment. With a proper program of strengthening and alignment you can have the strong core you started with. And, you may find that you’ll be even stronger than you were pre-pregnancy if you implement some of the appropriate core building exercises!
How to know if you have Diastasis Recti or DRA
To assess your abdominal status, lie on your back with knees bent on a flat hard surface. With your hand, fingers pointing towards your pelvis, place gentle pressure over the area just above your belly button. Allow your neck and shoulders to rise gently as if you are doing a small ‘crunch’. The goal is to feel the ridges of the long abdominal muscles that run alongside your belly button. If you can fit more than one finger into the space that connects those muscles, you should not proceed with any exercise program that is not specifically designed to protect and strengthen a DRA.
What NOT to do if you suspect you have DRA
Crunches, either ‘straight’ or rotational cause a tug at this midline tissue with every crunch. Instead of healing the gap, crunches may prevent it from coming together. Jogging and many cardio exercises will create those ‘tugging’ motions, as well. So, before starting any exercise program get confirmation of your DRA status and work with an expert in postpartum health to create an exercise program specifically for you.
Selfcare and treatment options
There are a few excellent programs that we can recommend.
Bouncing Back from Baby
This five-week program includes therapeutic massage, restorative bodywork, and movement education to support a return to pre-pregnancy alignment. You can schedule home or office visits in the Chicago area.
Women’s Health Foundation
This organization was founded to support research on and advocacy and education for women’s pelvic health. They offer great tutorials online, an exercise DVD, and referrals to pelvic health experts.
Developed by Julie Tupler, author of Maternal Fitness (Simon& Schuster) and Lose Your Mummy Tummy (DaCapo), the Tupler Technique includes an exercise program and use of a Diastasis Rehab Splint. An online support program and some regional referrals to trainers are available.
Because incorrect exercise can exacerbate DRA, there is value in meeting with a professional to provide assessment and ongoing support. If you can’t find someone through the above resources, you can ask your midwife or doctor for a referral to a physical therapist or physiologist who specializes in postpartum fitness and is an expert in this area. Every body is unique and the level of imbalance/asymmetry or muscle weakness in one woman will be different than in another woman.
While we advocate that you get professional support, it will be your own efforts at daily strengthening and alignment that will facilitate healing. As you learn the strengthening exercises and bring more awareness to your posture and positioning (even how you get up from lying down or sitting), you will find greater ease in movement and more comfort every day. As a postpartum woman you’ve made room and space for your baby in your body and the strengthening exercises that ‘pull you back together’ can feel energizing and empowering. I know it can be challenging to find time to exercise when you have a new baby, but this act of self-care will allow you to stay centered, strong, and active as your little one grows!