10 Sep I’ve Had The Baby, Why Do I Still Look Pregnant?
I have had several enquiries lately from patient’s in the early days post delivery contacting me wanting advice on how to manage a rectus diastasis, or abdominal muscle separation. This is an extremely common condition where the stretching of the growing uterus increases the distance between the two sides of the rectus abdominus muscle (the one that gives you your six pack!). It occurs in 70-100% of women during and after pregnancy. The abdominal muscles underneath the RA will also have been stretched and weakened during the pregnancy period.
The abdominal muscles have an important role in supporting your lower back and your internal organs, so ensuring you regain abdominal muscle stability is important in the post natal period.
How can you minimise abdominal muscle separation during pregnancy?
- The shorter the muscle length of the rectus abdominus, the greater the chance that it will separate as it stretches. Therefore, sit ups are not advised during pregnancy. This includes avoiding doing a ‘sit up’ to get in and out of bed. When you are pregnant you should roll onto your side, and use your arms to push up into sitting on the edge of the bed. You should also do the reverse action to lie down; sit on the edge of the bed, use your arms to lower onto your side, and then roll onto your back.
- You need to avoid any movement which causes ‘coning’ of your tummy. This is when you see the center of your belly rise up into a peak.
- Learn how to ‘brace’ your deep abdominal ‘core’ muscles. This will help you to support your back and your growing uterus. You can do this by pulling up your pelvic floor muscles, your Transversus abdominus (or the deepest abdominal muscle) will switch on with a pelvic floor contraction. Try pulling up your pelvic floor muscles and if you rest your hands gently on your lower abdomen you should feel your lower tummy gently contract. If you are unsure, a women’s health physiotherapist can help teach you how to do this.
- A maternity support belt, some tubigrip or SRC pregnancy shorts may help you to minimise the forward pull on your belly that occurs as your uterus grows.
How can you regain abdominal muscle stability after you give birth?
- For the first 6-8 weeks, it is advisable to use an abdominal support device for larger separations (greater than approximately 5cm). There are many options that can be used to do this.
- In some hospitals the physiotherapist may fit you with tubigrip before you leave. In my experience I find this rolls quite easily which can be a little annoying.
- The SRC pregnancy shorts have been extremely popular in recent years, with many patients reporting good results. They are very expensive, however, some health funds were offering a partial rebate, so it may be worth giving your private health insurer a call to see if they still do.
- You can also purchase ‘shapewear’. In the hospital I had my twins in, the physiotherapist on the ward gave me a pair to take home. These were the standard shapewear you can easily buy at Myer or David jones.
- There are also abdominal binders that you can purchase from a chemist or online, and for my second pregnancy I purchased a ‘dale brace’. I actually really liked this, as I could tighten the brace easily as my tummy came in as it did up with Velcro. Whereas, with the shapewear I really needed a smaller size a week or two after giving birth, but with twin newborns at home, and recovering from an emergency caesarean, I never managed to get out to purchase a smaller size. With the abdominal binder version, I used the same one the whole time and could tighten it as I went.
The bottom line is, there are lots of options out there, if you have a large separation it is worth choosing one of them and wearing it for the first 6-8 weeks.
- Engage your ‘core’ and learn to brace. See how to do this above in the pregnancy section. Doing this exercise on all fours is a good place to start. Your physiotherapist can then progress this exercise to strengthen the abdominal muscles in a variety of more challenging exercises.
- The advice regarding getting in and out of bed, and avoiding coning remains the same after you have given birth as well.
If you have any doubts at all, contact a women’s health physiotherapist to seek assistance.