Updated: Nov 4, 2020
One of the first things people ask me when they are starting to think about ‘getting back into shape’ postpartum is “how can I get rid of my belly?” My answer is always: embrace it for now, it carried your child into the world securely for 9 months, now give it the same time to settle back down.
With the abdomen is it really important to think about what went on during your pregnancy. Your stomach grew to several times its usual size, it carried around 10lbs of baby + placenta which undoubtedly put pressure on not only your abdominal musculature, but also the lower back and pelvic girdle. I am going to focus on Diastasis Recti Abdominis (DRA) which is “a separation of the two muscle bellies of rectus abdominis” (1) - the stomach muscles that run vertically either side of your belly button.
“Diastasis Recti is the result of excessive intra-abdominal pressure or loading” (3). Put plainly, as your baby grows your stomach expands to accommodate and at a certain point the stomach muscles will separate naturally. This happens in the majority of pregnancies (British Journal of Sports Medicine) and there is not too much you can do to stop it.
It is how we deal with it after birth that is important. The lengthening and separation of the Abdominis Rectus results in a weaker stomach which often has a knock on effect to the back muscles - causing weakness and pain. Furthermore, as a symptom of intra-abdominal weakness and pressure, the risk of hernia and prolapse is higher if left untreated. Although we are likely to focus our energy on the aesthetic of the stomach muscles closing, ultimately the correction of the muscles from the inside is more important.
Ideally we would like our stomach muscles to knot back together naturally, the NHS states this is common after around 8 weeks postpartum, especially if they are just slightly separated. My experience with my post-natal clients tells me that the vast majority of people have some sort of DRA several months after the birth of their baby - particularly after number 2. “For many women the gap remains widened at 8 weeks, and left untreated, this distance at 8 weeks remains unchanged at 1 year postpartum. (Coldron et al 2008, Liaw et al 2011).(3)
There are exercises that help to promote the knitting back together of this muscle group - and equally moves that are contra-advised. I would recommend a cautious approach, and not to rush the process.
How do you spot DRA?
You will definitely feel different after giving birth! The stomach will be softer, with less support from the interior muscles. After around 6 weeks, check if you have signs of DRA. Lie on your back with you knees bent and feet hip width apart. Take your head and shoulders off into a crunch position and allow your stomach to ‘pop out’ - don’t suck it in, allow it to be a dome. You can then take 2 fingers a press gently into the area around your belly button and see if there is any separation there. It should be fairly easy to identify.
Photo credit: www.tummytribe.com
What to do at home to help with DRA?
Pelvic Floor exercises - these will help engage your core from inside, promoting the stomach muscle to re-engage. Lying flat on your back, tilt your pelvis forward and suck up/engage the pelvic floor muscle inside. Hold for 5 seconds and release. Repeat. An alternative exercise is based on all fours, round your back and look to your stomach, try and engage your core. Reverse and arch your back and look up - in this position suck your pelvic floor muscles in. Repeat.
Lie on your side with your knees slightly bent, let your tummy relax and breathe in gently. As you breathe out, gently draw in the lower part of your stomach like a corset, narrowing your waistline. Squeeze your pelvic floor muscles at the same time. Hold for a count of 10, breathing normally, then gently release, repeat up to 10 times. (NHS2).
Find your deep stomach muscles and activate them when going about your daily life. Firstly, lie on your back and focus hard on your abdomen. Think of engaging your belly button with your spine - don’t suck it in, instead imagine it tightening, and also drawing in from the sides of the body. With a bit of practise these muscles will become easy to activate. They further work to promote great posture which supports the spine.
Avoid crunches and anything twisting as this will cause the muscles for shear against each other. Planking may also be unadvised, particularly if you have more than a few cm of separation, or think you could be susceptible to a hernia.
A pilates class make help you to really find and re-engage your Abdominal muscles, or a targeted approach with a personal trainer could help you kick start your post-natal fitness journey.
Finally, remember your stomach muscles worked really hard throughout your pregnancy to carry your baby so treat them with respect after the birth, and help them find their strength again.
MAMAWELL always recommends seeing your GP before trying any new exercises and if you feel your DRA is an issue, please seek medical advice from a women's health physio.
Check out The MAMAWELL Method to help you get physically strong and energised without exacerbating abdominal separation. Click here for all the info!
British Journal of Sports Medicine.
Jorun Bakken Sperstad, Merete Kolberg Tennfjord, Gunvor Hilde, Marie Ellström-Engh, Kari Bø
“Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain”. June 20 2016