Diastasis recti: A "gap" in care

When a mom comes to my class in the postpartum period, I always ask if she has a diastasis recti (DR). "A what?!" is the most common response.  What the heck is "diastasis recti"?  If you have never been pregnant, chances are you've never heard this term.  Let's be honest- even if you have been pregnant, you may not know what this means!  According to biomechanist, Katy Bowman, a DR is "an unnatural distance between the right and left halves (of the rectus abdominis), meaning that one (or both) of the halves has pulled away from the midline of the body."  We often hear an explanation of a "split between" or "separation of" the ab muscles, but given that the rectus abdominis is a set of separate muscles on the right and left sides of the body, there is always a little bit of a natural space between the sides at the linea alba (midline). A DR is when this gap has moved further from the linea alba than is natural for that particular person. Usually, no pain is felt as a direct result.  

So why do I bother checking in with new moms in my classes?  Many moms are concerned with "getting their body back" after having a baby, especially in the mid-region, which may feel flabby, weak, or just stretched out.  Looking to solve this "problem" (I put that in quotes because the real problem is not the post-baby body, but the pressure we feel to go back to something we no longer are- a blog for another time!), moms may start a regimen of crunches, planks, or other intense abdominal pressure that contributes to DR and only makes the weak paunch worse!  While there is a common understanding that we should take care while pregnant, few understand that the postpartum body is even more fragile than the pregnant one!  Self-care is critical in this time!  

Note that I wrote "check in" with new moms, not "check" new moms.  As a pre & postnatal yoga instructor, it is my job to educate and empower, but it's out of my scope of practice to diagnose anything, including DR. I rely on doctors to diagnose my students and provide them with medical treatment/ guidance.  Unfortunately, when it comes to DR, doctors aren't doing what I have erroneously perceived for many years to be one of their jobs in tending to postpartum moms. After so many of my students came back to class after having their babies and shared that nobody had talked to them about DR, much less checked for it, I connected with a friend who is a well respected obstetrician in the area.  I was shocked at what she shared!  To sum it up in a nutshell, she had never even heard of DR until she was out of medical school and numerous patients were asking her about it. (She then educated herself so she could help her patients.) 

Apparently, DR is just not something OBs are taught to diagnose or treat. The likely reason is that DR is considered cosmetic by insurance companies, and therefore something they are not willing to cover. And doctors tend to approach issues medically- in other words, treating with medication or surgery, which is uncalled for in the vast majority of cases of DR, particularly those in the postpartum period. So it makes sense that doctors would not check for something that surgery is not the answer to and insurance wouldn't cover anyway.  And herein lies the gap in care: doctors have the scope of practice to check for DR, but cannot/ will not treat it, so they don't bother diagnosing.  As a yoga instructor, I do not have the scope of practice to check for it or diagnose, but I do have the knowledge and training to help most moms repair their DR through exercise and simple lifestyle changes. And I can't help them if they don't know they need it!

That said, let's assume a new mom knows she has a DR.  If a typical postpartum gap between the abs isn't painful and is considered cosmetic, why bother with it anyway?  (Seriously, you have so much to worry about when you are a new mom!) Because from a functional health perspective, DR is NOT cosmetic- a large gap between the rectus abdominis can lead to other issues over time: digestive problems, back pain, pelvic floor problems, etc. And in immediate terms, new moms want to feel strong, healthy, and of course look good! Which is why they are at risk to worsen their DR in the first place. 

So what is a new mom to do!?  First, DO ask your OB or midwife at your postpartum visit to check for diastasis recti. The more moms ask, the more providers will realize it's something they should know about.  If the response lacks confidence (like, "oh, I'm sure you're fine, why are you worried about that?" or the provider barely touches your tummy- your abs will need to be engaged and palpated firmly for a proper check- then says you are fine), know that you may not be able to trust their diagnosis (or lack thereof).  I say this not to undermine the wonderful OBs and midwives in our community- I mention it because I have had a number of postpartum students given the pass by their health care providers to start intense abdominal exercise only to worsen a slight DR to a very problematic one.  

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Second, check yourself: lie on your back with your knees bent, feet hips distance apart, take a deep breath in and raise your head on the exhalation.  This will be enough to engage your ab muscles, so that you can feel for the gap that runs vertically down the center of your torso.  You will need to press firmly while your head is lifted.  I find it easier to feel right above my belly button, then follow the little "valley" of the linea alba down my torso.  See the pic on the right for a little inspiration. (Yes, underneath our mom paunches, we do have those same set of muscles.) If the gap is the same width all the way down- about a finger or so wide, you're likely without a DR.  If there is a place where it feels wider, then you may need to do some rehabilitative exercises to bring it back and make some changes in your everyday habits in order to fix the underlying causes.  Which brings me to the next point...

Third, making simple lifestyle changes to improve posture, alignment, and overall structural health is good advice for everyone and will have positive effects on the body, including core stability and preventing DR. In addition, if you're baby is less than six months old, err on the side of caution!  Focus on the simple lifestyle changes in how you sit, stand, and move. Avoid high impact abdominal exercises and start slowly and mindfully when the time does come. Yoga, with the guidance of a qualified postpartum yoga instructor, is fantastic way to move your postpartum body!

And lastly, if you are not sure, or you think you have found a gap, find a physical therapist who specializes in postpartum issues- definitely in their scope of practice to both diagnose and treat diastasis recti.  If you are in Silicon Valley, ask me for referrals!

DR is not uncommon in the immediate postpartum period, and for most people it is easy to address.  Just be aware of the support you need and who is best suited to provide it.  Avoid the "gap" in care!  

To learn more about Diastasis Recti, check out Diastasis Recti: The Whole Body Solution to Abdominal Weakness and Separation by Katy Bowman. She also has a wonderful podcast called Katy Says.