I spent much of my career as a trainer working with postpartum moms. I was lucky to work with a mentor in San Francisco with extensive experience working with women, specifically during pregnancy and post-birth. She taught me a lot about how to keep the body safe during pregnancy and one distinctive lesson was diastasis recti. Diastasis recti happens when the connective tissue (called the linea alba) that runs between the left and right sides of your abdominals doesn’t rebound completely post-pregnancy. The linea alba thins out in response to changing hormone levels during pregnancy, in order to accommodate the enlarging uterus. This is necessary, but sometimes it can overstretch and not completely shrink back after birth (imagine an overstretched rubber band). This can leave you still looking a few months pregnant, whether you still have excess weight or not.
It is shocking how many women simply think they’re still carrying around pregnancy weight for years after giving birth, only to eventually learn this was the issue. I worked with a woman in San Francisco who had been diligently training for ten years before meeting me, she ate a healthy diet and had a tall, thin body shape. But, as she described it, “looked 6 months pregnant.” Turns out, she still had a three-finger separation twelve years after giving birth! She cried when her doctor confirmed the separation, and we did very specific exercises to slowly but surely fix the issue. Yes, she had been working out – lifting heavy weights, doing dynamic HIIT movements, and core exercises like crunches. None of these will improve diastasis recti, and actually can make the issue worse!
How do I know if I have it? An experienced Pilates instructor, physical therapist, or obgyn can measure the “degree” of separation you have. You’ll simply lay on your back, with relaxed muscles. The practitioner will place her finger along the center of your abdominals. She’ll ask you to gently sit up (like you’re doing a crunch) and she will be able to feel if there is a gap there and how big it is (often you can feel it yourself as well). It usually ranges from 1 to 4 fingers. Nearly half of women will have at least a two-finger separation immediately after giving birth (many people already have a one-finger separation without ever getting pregnant)! In most cases, through specific pelvic floor and abdominal exercises, this separation can be corrected. Often it will even correct on its own for 1-2 finger separations (1-2 actually isn’t even considered severe enough to be labeled diastasis recti, but can contribute to a protruding belly). For level 3-4, it’s usually recommended to work with a physical therapist or specialized Pilates instructor. Some severe cases do require surgery to correct completely; this is rare.
Can I prevent it? There are many factors that contribute to diastasis recti, and not all are in your control. Pregnancy after 35, being pregnant with multiples, gaining excessive weight during pregnancy, being petite, and improper exercise form can all be contributors. Does this mean you’re guaranteed to get it if you check any of these boxes? Or that you can’t get it if these factors don’t apply to you? Of course not!
Is it harmful? Diastasis recti isn’t all about looks. It can cause back pain, urinary inconsistency, painful sex, and imbalances in the hips or pelvis.
Let’s focus on exercise, one of the easiest factors you can control. When you are engaging your abdominal muscles while pregnant, whether getting up from a laying-down position or in a full-blown workout, your belly should always stay round. What I mean: say you lift your shoulders off the ground like you’re doing a crunch, do you notice a triangular shape, “point,” or bulge, in the center of your belly? We want to avoid that! Your pregnant belly should always stay round while exercising. Watching for this bulge, using lighter weight, lowering your excursion level, or completely stopping an exercise are all helpful. The point or bulge you see represents extra pressure on the linea alba, which is why we want to avoid it. Whenever getting up from a laying down position: roll onto one side, then use your arms to help push up to a sitting position.
Work with an expert. First, you should work with a pro. Find a physical therapist or Pilates instructor (one who specializes in postpartum exercise) to show you how to do the moves that will help you heal. The line between proper and improper form is so subtle, having an expert there is critical. There are great online programs, just be sure to get the okay from your doctor and get her recommendation on how to proceed. If your doctor is dismissive or doesn’t know how to check you, get a second opinion.
What types of moves help? Very low weight, low-intensity abdominal work will be the name of the game. Further, you will always work the core with gravity working in your favor – meaning the position is one that naturally flattens your belly towards the ground (like laying in your back) versus having to work against gravity to flatten the abdominals (like a plank.) Jerky or big motions, like crunches are a big no-no for those trying to heal diastasis recti. Some moves that can help:
Tactile feedback. Use your hands to act as an extra support system. For example, When doing core work laying on your back, spread your fingertips wide, place your hands on either side of your abdominals, and push your hands down and towards each other (like you are wearing a corset). This will help keep your abdominals in the proper position once you add movement.
Breathwork. Learning to breathe with your movements can be powerful. Lay on your back with your hands on your ribcage. As you inhale, fully breathe into the diaphragm (you will feel the area below the ribcage fully fill up with air). As you exhale, contract the deep abdominal muscles like you are wearing a corset that’s being tightened. Fully expanding the diaphragm with deep breathing helps support and protect the spine (versus the shallow chest breathing many of us do naturally).
Bridge Lifts. Lie on your back with your feet flat and knees bent. Place your arms at your sides with your palms against the floor. Inhale slowly and deeply into your diaphragm. As you exhale, lift your pelvic area toward the ceiling until your body forms a straight line (your knees will be at the highest point and your shoulders as the lowest). Inhale while holding the pose, and then exhale as you carefully roll your spine back onto the floor.
Single leg flat back. Lie on your back with your feet flat and knees bent. Place your arms at your sides with your palms against the floor. Gently (one leg at a time) bring your legs to tabletop. Keeping your low back pressed against the floor, slowly lower one leg towards the ground (only go as low as you can without your low back lifting). Slowly bring your leg back, then do the same on the other side.
Kegels. If you haven’t learned to do proper kegels, your best bet is to head to a pelvic floor physical therapist, who can help you learn proper technique. This is critical after carrying a baby.