Mama D's Story with Abdominal Separation

It was her second pregnancy. Her second c-section. “Mama D” was a pro, a tried and true Mama. She had a few reps under her belt and felt ready for her second cesarean section. At least this time it was a planned c-section. She did all the right things. She took her birth education classes. She attended her OBGYN appointments right on schedule, and even researched and advocated for a gentle c-section.  Overall, her baby’s birth day couldn’t have gone better. Mama D was calmer this time around, more prepared. Baby J was placed on her chest right after delivery, and she was able to watch the whole thing, leaving her feeling empowered, in control, and emotionally attuned to the experience of bringing life into the world. 

In the days and weeks afterwards, Mama D and her partner were adjusting to having a newborn AND a toddler at home, which was a big adjustment to say the least. Although tired and sleep-deprived, she thought she was doing fine physically, even the doctor said so. She got the “all clear” at her 6 week check up. A few more weeks passed and Baby J was 9 weeks old. Mama D was 9 weeks postpartum. She was savoring the sweet moments with her 2 Littles. Life was good, BUT….her body felt extremely weak still- like jello. Specifically, her core felt non-existent, and her “Mommy pooch” showed no signs of improving. People at the grocery store were still asking her how many months pregnant she was (even though she had her 9 week old with her- but that’s another story for another time). 

After the 20th person asked how far along she was in her pregnancy, trying not to let her feelings get hurt, and holding back tears, she became determined to find answers. Surely there was a solution out there. So, Mama D did what we all would do in this situation. She dove down the Google rabbit hole, trying to find answers. Like, SUPER deep down the rabbit hole. She needed answers. She googled “why do i still look pregnant after baby?”, mommy pooch, abdominal separation, diastasis rectus abdominis, DRA after c section. There were so many names for it! How do you even say that? Diastasis Rectus Abdominis? Let’s go with DRA for short. 

Once she knew what to call it, Mama D could really only find an endless list of contraindications, or a list of what NOT to do. 

• Don’t lift anything heavier than your baby

• Don’t plank

• Don’t do sit ups

• No ab exercises 

• Don’t twist your spine

• Don’t squat

• And more completely unrealistic things of what not to do....don't lift anything heavier than your baby? What in the actual HECK!?! What about if baby is in a carseat? That thing weighs double what the baby does by itself! What about the stroller? Groceries? The toddler who still needs our love and attention?!? Are you kidding me? That is some bullsh** advice. Not realistic in any way whatsover.

Like I said.... an endless list of what NOT to do, but not much useful advice on what to do or what could actually help. The advice out there seemed to verge on the border of useless or the nuclear option- surgery! Mama D knew she didn’t want to go under the knife for a tummy tuck unless it was absolutely necessary. Not finding decent information, she became frustrated, even hopeless as she googled this stuff in the middle of the night while cluster feeding. 

Then one day, a beacon of hope emerges. Mama D went to visit her CrossFit friends. They wanted to see Baby J and she hadn’t been back to the gym since just before her due date. She was sharing her experience when one of them, obviously highly health-literate, insisted she check out pelvic floor physical therapy. 

On day 1 of her Empowered Mama Assessment, I checked her abdominals for an ab separation and found she had a 4 finger separation in multiple areas along her midline. My fingers sank right in, with very little tension found in the linea alba- the connective tissue line that runs in the middle of the 6-pack muscle. Mama D had no idea that having a c-section automatically gives you a diastasis recti since the doctor has to split the rectus abdominis muscle in half to gain access to the uterus. There is absolutely no way you’re coming out of a c-section without a DRA just due to the surgical necessity of getting through the abs to get that beautiful baby out. 

After giving her a ton of education, I assured her that this is something we can fix. Physical therapy is the gold standard for c-section recovery, postpartum recovery, ab rehab- specifically pelvic floor physical therapy because of how much we can focus on the entire core unit, including the pelvic floor and diaphragm. 

When working with Mama D through her postpartum recovery program we worked on

• Improving deep core muscle activation, strengthening, and control, specifically of the transverse abdominis muscle (TA muscle)

• Diagphragmatic breathing

• Intraabdominal pressure management with exercises and daily activities

• Pelvic floor recovery, stretching, activation, and coordination with other core muscles

• And eventually lifting weights utilizing her abdominal pressure management techniques and core activation during lifts to protect and progress her core and abdominal muscles to the next level

What actually is a Diastasis Recti?

Separation of the abdominal muscles, aka Diastasis Rectus Abdominis (DRA), is a BIG concern for many postpartum Mamas, like Mama D in the story above. A diastasis recti isn’t just an aesthetic concern. Having an ab separation is a breakdown in the functional deeper core unit that is meant to give our body stability. Our body, specifically our nervous system (Think our brains, our nerves), loves and CRAVES the feeling of safety- the feeling of stability. Our nervous system will do anything and everything to create stability around our joints when it's lacking. If our core is supposed to be strong and give our spine the stability it needs, but there is a dysfunction in our core like a DRA, this can and usually does lead to bigger problems. People with a diastasis recti are very likely to get back pain, knee pain, pelvic floor dysfunction, urinary incontinence, pelvic pain, sciatica, sacroilic joint (SIJ) pain, and even upper back, shoulder and neck pain- all because they have a breakdown in their deeper core unit in the form of an ab separation that was never rehabbed postpartum.

Preventing DRA during Pregnancy

Not to worry! Diastasis rectus abdominis can be fixed with conservative measures like pelvic floor physical therapy. Good news is that it is also HIGHLY preventable during pregnancy with the right training. It always helps to have the right expert on your team if you are pregnant to help you navigate the Do’s and Don’ts without being too restrictive for no reason. Our job here at Empowered Mama Physical Therapy & Wellness is to empower you with information, while also teaching you how to best prevent the most common pains and complications during pregnancy and postpartum, while also giving you the most comprehensive postpartum recovery that exists in SoCal or online with the purpose of tailoring everything to your active lifestyle and your unique goals. 

If this blog article hit you right in the feels, or awoke something in you that calls you to a higher, better way of living, without pain, without restriction- then schedule an ALWAYS FREE phone consult to see if we’re a good fit for each other and if we can help you along your Empowered Mama Journey.

As always, 

Keep It Up Mama!