A Holistic Approach to Treating Postpartum Diastasis Recti

Parents often want to quickly lose their baby bump after giving birth. But there are many reasons that a protruding belly ‘pooch’ can persist well into postpartum months. One of the most common is a condition called diastasis recti (DR). Simply put, Diastasis Recti is the separation of the abdominal muscles along the middle of the abdomen that occurs during pregnancy to allow room for baby to grow and develop. 

The abdomen has a thin line of connective tissue, the linea alba, between the two rows of muscle and during pregnancy this connective tissue stretches, allowing the muscles to pull apart. After giving birth the body has a system for healing, and often the linea alba tightens up and pulls the muscles back together. But while it often resolves, it certainly doesn’t always resolve on its own. Persistent diastasis recti may appear as a ridge-like protrusion along the midline of the abdomen, and it be more pronounced during abdominal straining.

A study in the British Journal of Sports Medicine found that at 6 weeks postpartum, 60% of birthing people still had some separation of abdominal muscles, and 32% still had at least mild diastasis recti at 12 months postpartum.¹ 

Refer to this video for instructions on how to assess for Diastasis Recti. If you find a gap—don’t panic! This is a very common finding. Luckily, there are some basic tools you can employ to help speed recovery.

Treating Postpartum Diastasis Recti Non-Surgically

Exercise

Generally speaking, I recommend people rest for about two weeks after birth, with or without obvious indication of diastasis recti. Your body has been working hard for the last 9-10 months, it needs time to recover! The only thing you should concern yourself with during this time is resting and feeding your baby. Two weeks after a normal vaginal birth is a good time to start incorporating some basic daily exercises to strengthen core and pelvic floor muscles. Be sure to start slow! Pelvic tilts, kegels, arm/shoulder stretches, and walking are a perfect place to start. 

At six weeks, you’re probably ready to resume or begin a regular exercise regimen again, if you had an uncomplicated vaginal delivery. If diastasis recti persists at this point, you’ll want to avoid creating unnecessary intra-abdominal pressure when you exercise. Exercises that you may have previously associated with a building strong core may actually make the condition worse. This means that traditional abdominal crunches and curls are off limits during this time, as well as heavy lifting, or any exercise that causes your tummy to bulge out. Your pelvic floor and abdominal muscles are still not strong enough for the pressure these activities can create.

The following exercises are great for strengthening your core in a much safer and effective way:

• Side planks

• Cat/cow yoga stretches

• Wall sits

Make sure you are maintaining good posture. Sitting up straight, bending over at the hips, and squatting to pick things up are great daily habits to keep your core muscles strong.

Maternity Compression 

Maternity compression is a great way to support all the work your body is doing, both during pregnancy and afterward during the postpartum period. After baby is born, it may be tempting to reach for that shapewear you used in your pre-pregnancy days when you needed some help squeezing into that little black dress. Don’t do it! I understand why the side slimming effects of shapewear might sound nice, but sometimes it causes more trouble than it’s worth. Think of your abdomen like a tube of toothpaste: if you squeeze the middle of it, where does all the toothpaste go? To the top and bottom, right? One of the issues with side slimming in the postpartum is that it increases the pressure that’s put on the pelvic floor, which the pelvic floor is not ready for. Postpartum compression is designed to support the whole core—back, abdomen, and pelvic floor, which helps new moms keep good posture, especially given all the time mom now spends feeding, holding, and changing baby.

Postpartum recovery compression garments support both your pelvic floor and your abdomen so that all of these areas will come back together to form a strong core. Once these muscles sets have had the time they need to form a firm foundation around your abdomen, they will hold you steady during your daily activities. Another reason to choose postpartum compression over shapewear: it can be eligible for coverage by your insurance company. 

 References:

1. Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine 2016;50:1092-1096.

About the Author

Rebekah Mustaleski is Compression Director with MotifMedical.com and a Certified Professional Midwife with Roots & Wings Midwifery in Knoxville, TN, where she promotes evidence-based maternity care for families seeking an out of hospital delivery. She is working to improve maternal outcomes during the childbearing year and to promote a sustainable business model for midwifery practices across the country. Rebekah is co-owner of Roots & Wings Midwifery, LLC as well as Treasurer for the Tennessee Midwives Association.