“What is stomach separation exactly?”
The first thing to know is that diastasis of the rectus abdominis muscle (DRAM) occurs in 100% of postnatal women to varying degrees due to the obvious stretching your stomach muscles and surrounding tissues have to undergo to enable bub to have the room they need, so you are not alone. The difference is the amount of separation and how much someone can control it. Anatomically, a DRAM is the lengthening of the connective tissue (the linea alba) that runs between the two sides of the ‘six-pack’ muscles (the rectus abdominis muscles). It is not a splitting or separation of the muscles themselves.
“How do I know if I have it?”
The best way to know if you have a DRAM is to have it assessed by a Physiotherapist. The most common thing that women notice if they have a DRAM that isn’t well control is a noticeable doming or ‘tenting’ down the middle of their stomach when they use their abdominal muscles, such as when sitting up to get out of bed. It is important to note that not all women with a DRAM will have doming.
“I was told I have a 5 finger separation the day after giving birth, which seems like a lot. Should I be worried?”
If you have had your assessment soon after birth, the number of fingers that you get told can paint a horrific picture, with some women being told that their separation is more than 10cm. Having a baby is a big deal, and full of new information, stress and the unknown. When we add the words ‘abdominal separation’ to the mix, our minds can jump to crazy lengths and think that our muscles are now miles apart and we are now destined for lifelong core weakness and other issues like low back pain! It is important to note that during those first weeks following giving birth, your stomach is going to be the most stretched, and your core the most tired from the physical stress of those last few weeks of pregnancy, labour, and the birth itself (whether that be vaginal or caesarean section). You will find that by the 6 week mark, your body will have already begun working on retensioning the tissues around your stomach and that distance has begun to lessen.
“What should I avoid while I wait for my 6 week follow-up appointment?”
During those first 6 weeks of your baby’s life, your focus should be on resting, recovering and getting to know that little soul you have brought into the world. Now is not the time to be focusing on getting your body beach ready, or stressing about not being able to hit the gym. Any new Mum should avoid certain things in those first 6 weeks to aid in your body recovering as best you can, within reason (some are more difficult to avoid with a little one, or if you also have some older children at home). Things to avoid specifically for DRAM are:
- Excessive use of your abdominal muscles, such as sit-ups or crunches (this includes sitting up out of bed!)
- Strenuous exercise such as running or strength training
- Heavy lifting
“What about lifting my pram, and my 3 year old that is needing me a lot at the moment?”
For many, those previously listed things to avoid can seem unachievable, so we have some tips that can try to make these easier.
First things first. Don’t stress when you do have to lift something or use your abdominal muscles as it is bound to happen. It is just important that you avoid those things as often as you are able to.
A good first example is to log roll out of bed (roll on to your side then push yourself up into sitting), rather than sitting straight up and using your stomach muscles like you would in a sit-up at the gym. This is harder to do if you are holding bub but just do what you can, and definitely log roll if they aren’t with you.
Another tip is to try and walk instead of driving to places if they are not too far so that you can avoid lifting your pram in and out of the car. This also allows you to get some gentle exercise in, just remember to start off with shorter distances and build yourself up. If you need to use your car, try to recruit a friend or family member to come on some errands with you in those first 6 weeks so that they can help you with your pram or capsule, and other heavy items such as groceries.
As for your toddler? This one can be hard as a crying child can cause your logic to go out the window, but if you can, try to go down to their level rather than lifting them up to you, or get them to climb up to you if possible, for example if you are on the couch. There are going to be times when you have to lift up your toddler and that is okay! Just do your best to not lift them when you can.
“What exercises can I do for my stomach separation in those first 6 weeks before I am cleared to return to exercise?”
The following are some gentle core exercises that you can try out in those first six weeks, a few times a day. You can even have bub nearby, maybe trying some tummy time!
Lie on your back with your knees bent and your feet on the floor. You should feel a slight arch in your lower back. Using your lower tummy muscles, gently flatten your lower back into the ground, then create that slight arch again. Repeat 10-15 times.
Bent Knee Fall Outs
Lie on your back with your knees bent and your feet on the floor. Place your hands on your hip bones/pelvis and feel if they are level. Without moving the other leg and keeping your feet on the floor, let one knee fall out to the side. Return to centre then do the other side. The goal is for your hip bones/pelvis to stay level and not rock side-to-side. Repeat 10-15 times each side.
Cat and Cow
Get on to all fours, with your hands underneath your shoulders and your knees underneath your hips. Pressing through your hands, knees and feet, gently round your spine up towards the ceiling and tuck your chin towards your chest. On your return, try to find a position where your lower back has a gentle arch (not excessive like you would have seen towards the end of your pregnancy). It might be easier to try this in front of a mirror at first. Repeat 10-15 times.
“I’ve been cleared by my doctor to return to exercise, but I am not sure what I can and can’t do”
Your return to exercise will be different to another Mum that you know, because your goals, fitness level and DRAM are unique to you. If you are unsure about the best way to return to the things that you love, we recommend coming in to see one of our Physiotherapists for an assessment so we can give you the best, tailored advice.
The bottom line?
All Mums will have some amount of abdominal muscle separation after pregnancy.
Measurements taken soon after birth are likely to be much larger than those taken at 6 weeks.
Be sure to avoid excessive abdominal muscle use, heavy lifting and strenuous exercise in the first 6 weeks after having your baby.
You can begin some gentle exercises at home at your own pace, but remember that your focus is on resting, recovering and spending time with your baby.
Consider getting professional advice to aid in your safe return to exercise.