If you have met me in person, you have likely heard me speak a lot about abdominal separation, or diastasis recti. Abdominal separation is caused by intra-abdominal pressure, resulting in a separation of the rectus abdominals into left & right halves. Typically, this will begin in the second trimester of pregnancy and persists into the 3rd trimester. The degree of separation can vary and is often measured in finger widths, with 1 being normal to low and 4 or more being a high risk separation. However, length and depth of the separation should also be evaluated as well as a consideration for how long the separation has been present.
Although the condition of abdominal separation is not detrimental to your health (meaning you won't die), left untreated, it can negatively impact your quality of life. The greater the separation, the more likely you are to suffer from organ prolapse (uterine, bladder and rectal prolapse being most common).
At FITMOM, we recommend that you & your care provider check for abdominal separation once in the first trimester, twice in the second and three times in the third. By doing so, you create an awareness of the condition and can rehabilitate your core correctly in the post partum period. Engaging in effective abdominal exercises during pregnancy can keep your core strong and reduce/limit the degree of separation. Avoiding crunches during pregnancy is a good start!
Am I at risk?
Anyone who is pregnant is at risk for some degree of separation. However, some other factors may increase your risk:
- Genetics
- Carrying multiples
- Previous undiagnosed or untreated separation caused by previous pregnancies
- Engaging in sports or movement where your torso torques (Tennis, ultimate Frisbee, or any activity that causes you to repeatedly cross the midsection)
- Short midsection
After you give birth we recommend that you do a self-assessment at 2 weeks post partum to get a baseline and again at 6 weeks. In many cases, the separation will close on its own, however one should not make any assumptions.
It is vital that you have your abdominals assessed again prior to starting any traditional core exercises. Engaging in inappropriate core work can cause further separation and deterioration of your core muscles, leaving your midsection unsupported and at greater risk of prolapse.
Women with a high risk separation will need physiotherapy and in some rare circumstances, surgery.
In most instances though, women with low risk separation can often see full recovery when following certain protocols. Review our handout on best practices "Core Restore Tip Sheet".
If you are concerned you have a separation and would like to close the gap, please contact me. I would be happy to help you improve your core strength, rebuild your confidence and improve your overall conditioning.
There are many benefits to staying active throughout your pregnancy. Women who exercise regularly report a reduction in back pain, have improved circulation and experience less swelling (edema). They also reduce their risk of high blood pressure and gestational diabetes. Women who are physically fit also report having shorter and easier labour.
Have you ever wondered why that is?
Well, for starters a woman who is physically fit handles the physical demands of labour better because she is stronger and has improved endurance. Active women may also experience shorter labours because the baby us in the optimal position for labour and birth. If the baby is aligned well in the mothers pelvis contractions are more effective and labour will progress more quickly.
Towards the end of your pregnancy you may be less inclined to want to exercise and prefer to come home after work to lie down and rest on the couch instead. Considering the amount of time most of us spend sitting, either at a desk or in a car, lying down for hours at night may not be the best idea.
Limiting the amount of time a pregnant woman spends in supine or semi-reclining positions can reduce the likelihood of a baby becoming posterior (OP baby's occur in between 10-20% of all pregnancies). A woman who has an OP baby tends to report higher instances of back pain, back labour, and may experience longer labours because the position of the baby does not allow for even or consistent pressure on the cervix. Most babies, even those who are persistently OP will eventually realign themselves into position during labour and birth, but the labour experience may be longer and more painful than what you were hoping for.
So as tempting as it may be to recline on your couch and relax with your feet up after a day at the office, consider adding in these positions into your daily routine instead to encourage what is known as Optimal Fetal Positioning (Sutton& Scott)
- Spend time sitting on a birth ball (stability ball)
- Watch T.V. in a hands and knees position, add in pelvic rocking (Cat/Cow) and/or swaying of hips
- When standing, lean forward resting your hands against a table or a counter
- Avoid crossing your legs, which narrows your pelvis and doesn't allow your baby to turn
- Avoid lying down with your legs up
- Sleep on your left side
- Yoga postures like the tailor sit or cobbler are restful and helpful positions
- When you do sit on a chair keep your knees lower than your pelvis and your trunk slightly forward
Whenever possible, continue with light to moderate exercise like walking, yoga and swimming. You may have an easier labour because of it!
There are many coping mechanisms available to women as they progress throughout birth: position changes, movement, massage, touch, water therapy and medications are some that come to mind. However, today I thought I would share with you the simple and yet effective benefits of breathing.
Rhythmic breathing, often accompanied by low moans, is a universal coping strategy adopted by women across cultures. Women who are coping well with the surges of an increasing labour pattern typically move their bodies more (swaying, rocking, self-massage) and use their voice (moaning, chanting or other vocalizations ) thereby experiencing more effective relief from pain & stress.
There are two styles of rhythmic breathing that are often taught, both in a prenatal yoga class, or childbirth class.
The first is what we call slow breathing:
Slow breathing is best introduced in labour when the mother can no longer walk and talk through a contraction or surge, especially while at the peak. We teach women to 'sigh' her way through the contraction with full, audible breaths. This type of breathing pairs wonderfully with imagery. 'Each exhale is a relaxing breath' or 'Send each breath in to a tense area in your body and breath the tension out as you exhale'.
The second style is called Light breathing or Modified Breathing:
This style of breathing is best introduced whenever a woman becomes discouraged or finds that the slow breathing is no longer effective in distracting her or diminishing her discomfort.
When we teach light breathing we are teaching her to breathe more shallowly and more quickly, but still at a speed that she finds comfortable. An example may be two shallow breaths followed by a longer breath in between to prevent hyperventilation.
Most women respond very well to rhythmic breathing and almost all women develop their own instinctive rituals over the course of their labour, allowing them to cope with the increasing contractions of normal birth.
Rhythmic breathing is also known to quiet the mind, specifically the thinking part of the brain (cerebral cortex), allowing women to be more instinctive. It is also self-calming and encourages the body to release tension and enhances a sense of well-being.
References:
Simkin & Ancheta "The labor progress handbook" (2005)
Simkin "The 3 R's in childbirth preparation: Relaxation, Rhythm and Ritual" (2006)
Lowe "The Pain and Discomfort of Labour & Birth" (1996)
