One of the most overlooked areas of pregnancy is postnatal recovery. What do you do, how do you feel, and how do you help your body to recover once baby has arrived and all attention has turned towards the teeny tiny new little human? We got our German physiotherapist-expert Sabrina Nieland to answer some of the most commonly heard questions at her practice. If you are wondering what to do and how to proceed after childbirth, read on to find out how you can help yourself to fully recover!
1. There's still a gap of a finger's width, what can I do?
You can still put one or two fingers lengthwise in the gap between your straight abdominal muscles? Well, congratulations: you no longer have Diastasis Recti! A gap of one finger width is considered normal; the gap existed even before your pregnancy.
The straight abdominal muscles are anatomically separated by the linea alba- fascia. During pregnancy, this fascia softens and stretches to make room for your baby. Before your pregnancy the fascia was usually up to 1.5cm wide – you just didn't notice it because it was still very firm.
At the end of pregnancy your gap was usually several fingers wide, so if it is only one finger wide now, it means that your body has done a great job and readjusted the diastasis.
If you are not experiencing symptoms such as bloating, feelings of instability, or back pain, there is nothing else for you to do but do your regression exercises and you will notice that the one-finger gap will become firmer on its own over time.
2. According to tests, I no longer have diastasis recti, but I still look pregnant?
If manual testing suggests you no longer have a diastasis recti, but your symptoms resemble one – belly still looks pregnant, feeling bloated, unstable core, belly button protrudes, back pain, posture problems, pelvic pain, and so on – you might have a weak core.
With core weakness the reason for discomfort is not the enlarged gap between the straight abdominal muscles and the soft fascia, but the interaction of the abdominal wall muscles as a whole is not yet back to normal after birth. As a result, the muscles are not able to provide stability and the belly protrudes forward.
This particularly concerns the deep transverse abdominal muscle – the transversus abdominis: it acts as a corset and secures the inside of the belly. This is the muscle that was closest to your baby and that has been stretched the most during pregnancy. As a result, it often falls into a "slumber" and is difficult to find and reactivate after giving birth.
You then notice the abdomen is unstable and you can't properly feel the abdominal muscles or build abdominal tension. This explains the symptoms, which are similar to a real diastasis recti.
3. What are the best exercises for diastasis recti?
Unfortunately, there is no such thing as a magic exercise to heal diastasis recti. Any classical exercise, properly performed, can be good. Improperly performed, it can be counterproductive.
Whether it's a real diastasis recti or an abdominal wall weakness, the first step is to restore the action within your deeper muscles in order to generate tension in the soft connective tissue between your abdominal muscles (the linea alba) and thus make them firmer.
This means that your pelvis, abs and back muscles need to come back into harmony, stabilizing your center from the inside out. This interaction of the deep muscles also includes the most important motor: your breathing through your muscle of respiration: the diaphragm. A body center-activating breathing encourages the interaction of the deeper muscles.
Before your pregnancy, all of this simply happened without you even noticing it. However, with pregnancy, the coordination of these muscles has become unbalanced, making the body unable to resist pressure from within. This condition can lead to pelvis pain or even a persistent diastasis recti.
Maana here with a side note! If you do have significant diastasis recti, or pregnancy was hard on your body physically otherwise, you might want to consider trying out our Core Restore Postpartum Belly Band (Now -15% during Mama Wellness Week 11.-17.10.2021)! With weak core, all exercise can feel overwhelming so having that gentle hugging compression around your midsection can help.
4. I finished my recovery course – so can I do everything as I did before?
Congratulations on taking a postpartum recovery class – this is the first step towards a stable and healthy body. (Note, that this is standard in Germany. To my knowledge, not many other countries offer a staple class for postpartum women. Instead of this, you should look into mum-baby exercise classes, maternity physios, or talk with your GP or midwife about the options near you!)
Postnatal exercises aim to strengthen and stabilize you from the inside out. You have learned to feel and control your deep muscles, such as the pelvic floor and abdominal muscles, to optimize your posture and breathing. Ideally, you have learned many tips and knowledge for a body-friendly and gentle everyday life as a mother.
However, after your postnatal training you are still not completely recovered. Your organs need at least 9 months to regain their stability, as do the abdominal muscles and usually also to the pelvic floor. Think of the postpartum phase, i.e. the time until about 9 months after birth, as a rehabilitation phase after an injury: Step by step, you will regain your strength and be able to increase the intensity, e.g. in sports you should increase the intensity of the workout gradually … not from 0 to 100.
If you have any questions, feel free to contact your midwife or a pelvic floor therapist or postnatal trainer in your area.
5. Do I need to take a postpartum class as I had a C-section?
"I don't need to attend directed postnatal recovery classes of physiotherapy since I had a Caesarean section". Unfortunately, this is a widespread misconception, and I can only encourage you to attend a recovery course even after a C-section.
Your body needs to recover even after a caesarean section - your uterus has grown with your baby and needs support to return to its original size. Your abdominal muscles are elongated similarly to a vaginal delivery and the diastasis between the muscles is soft and unstable. What’s more, the pelvic floor in every pregnant woman is preparing for a vaginal birth (it doesn't know there may be a C-section needed. This means that your body is preparing for birth, cervix dilates, and everything becomes stretchier. Plus, the healing section wound, pregnancy-related changes to your posture, breathing and physical activity... all these issues are addressed in a good postpartum class.
In physical therapy practice, we see almost as many moms with pelvic floor problems or diastasis recti after caesarean section as after a vaginal delivery.
Lastly, these classes are a lot of fun, you learn a lot about everyday life with a baby and you can exchange ideas with other mums … so do yourself a favour and look into attending postpartum classes.
6. If something was not right, surely I would notice it?
I get often asked by mums how it is that their friend was able to jog 6 weeks after giving birth without having any problems.
Basically, the only thing we can say is: We’re all different! Many mums, whether after Caesarean or vaginal birth, feel perfectly fine after delivery and can do everything as they did before giving birth, without their body reacting with symptoms such as pain or urine leakage, even shortly after birth.
From a therapeutic point of view, it is still recommended to adhere to certain recovery principles and to wait with high impact activities, such as jogging and lifting heavy weights.
Organs, pelvic floor, and abdominal muscles are initially still very unstable and inactive and need some time to recover. As the pelvic floor has hardly any pain receptors, you might not notice at first when overloading but symptoms might arise later.
In my office, I often see women who have returned to “their sport” early on, feeling good at first, and then suddenly started having problems with incontinence or downward pressure. In many cases we find that their organs have dropped. According to studies, in menopause an organ prolapse occurs in every second woman. Therefore, it is better to wait a little while after childbirth so that your body can recover and restabilise, right?
If you want to find out more about your deep system and what to do and what not to do, you should find a physiotherapist specialised in postpartum and get individual advice, because everybody is different, and every recovery process is very individual. This is the reason you can look up postnatal recovery and you’ll find very vague guidelines only – every body is different and every recovery will, therefore, look and require a different approach.
So, there you have it. Postnatal recovery, that 4th trimester every mum goes through, is part of that 'it takes a village' mentality. Some mums truly 'bounce back' and good for every one of you - most, however, do benefit from that extra little boost you can get from a group or 1-on-1 maternity physio. Without going into it too deeply, you deserve all the help you can get, this included.
Help during your postnatal recovery isn't a luxury. It shouldn't be a question of 'can I afford this?' or 'do I really need this?'. We strongly believe it should be a given to every new mama. Which is why, if you have any questions left to ask, I strongly advise you to pop off a message to our Lola&Lykke Experts who can give you ideas and options!
Questions and answers by: Sabrina Nieland, our German maternity physiotherapy expert.