The post-pregnancy belly problem that nobody tells women about

January 15, 2018 7:57 AM

There’s surprisingly little research on diastasis recti, which affects at least 60 percent of postpartum women. As with many other postpartum complications that affect women, there is little good research on the condition. Women aren’t routinely screened for DR at the one standard postpartum visit that occurs around six weeks after birth. And if they do get a diagnosis, they are often told that core work — for instance, tons of crunches — will tone the tummy and thus, close the gap. But core work done improperly or alone won’t necessarily fix the problem. In fact, it can even make things worse. And over the long term, DR can compromise the stability and function of the core, and is linked to a host of other problems that can crop up even years after childbirth. Given that so many women are forced to learn about DR on their own, here is a guide for how to try to prevent it and address it from those who treat it.
posted by Blasdelb (16 comments total)

I‘m shocked by the state of postpartum care in the US. ‚Rückbildung‘ (postnatal rehab exercise classes, where instructors also look out for DS and other issues) are a standard part of postpartum care in Germany, just as 10 midwife home visits and, you know, maternity leave.

When I tell Americans this, they smile and say ‚oh, that‘s so nice!‘ - no, it‘s actually just basic healthcare, which is a human right.
posted by The Toad at 9:20 AM on January 15, 2018 [49 favorites]

A friend of mine has a bad case of this after the birth of her second child. I didn't know much about it before she told me about her case, but it's horrifying. She's trying to avoid surgery, but it seems likely.
posted by TwoStride at 10:37 AM on January 15, 2018

I didn't have (so far as I know) any problems with this post-partum, but I can remember the moment my abdominal muscles separated during my first pregnancy. It was a strange sensation, not painful, but like a zipper unzipping down the length of my belly. Or maybe that was something else entirely and that's just what it felt like. But that zipper feeling was very vivid and noticeable.
posted by Orlop at 10:48 AM on January 15, 2018 [6 favorites]

I second the Katy Bowman book on DR, and recommend - and yes, I’m aware the name is appalling - Lose Your Mummy Tummy by Julie Tupler. Prenatal yoga, belly-wrapping, and pelvic floor physical therapy are also helpful for DR prevention and recovery.
posted by sutureselves at 10:50 AM on January 15, 2018 [2 favorites]

The for-profit model for healthcare is quite good at producing profit. Health, not so much.
posted by theora55 at 10:51 AM on January 15, 2018 [9 favorites]

This comes at a good time, as my daughter is expecting her first any day now. Thanks!
posted by Thorzdad at 11:00 AM on January 15, 2018 [3 favorites]

Much like with post-partum incontinence, my chats with female ob-gyns go something like this:

them: any better?
me: yeah, but forget about jumping rope, right?
them: yeah damn kids. I haven't exercised without peeing in years
me: they really do a number on you
them: nobody tells you beforehand, don't they?
me: right
them: haha
me: hah...ha

and nobody offers a solution or physical therapy, we just... awkwardly laugh in shared motherly sisterhood and apparently accept that having children will wreck all your bodily functions forever.

I'm almost two years PP after my last huge baby and I need to be a little more assertive at my next visit, clearly.
posted by lydhre at 1:09 PM on January 15, 2018 [8 favorites]

Postpartum care in the United States is such a joke. I specifically asked my OB to check for DR at my six week checkup, and she said that she wasn’t able to, as she didn’t have any training, and referred me to, I fuck you not, “a yoga instructor”. Not a specific person , she just said that sometimes yoga instructors know how to check. This was at a top research hospital in the nation, UCSF.

Let’s not even mention the two hand surgeries I had to get postpartum due to “mommy’s thumb” which, again, few doctors have any idea about. And which my insurance tried to deny coverage for, since, really, do you need working hands? “Oh, you’re having pain in your hands? Have you tried resting them?” Yeah, I’ll get right on that with a newborn.
posted by Jaclyn at 1:12 PM on January 15, 2018 [12 favorites]

As an Osteopath (UK version) I see a lot of these, not just on post-partim women but also on mid-fifties men with bellies! They are quite distinctive.

An important thing to note from that article is that it talks about all sorts of horrible symptoms “caused” by the diastasis, but it is pretty likely that most of them are co-morbid with the post-partum, rather than directly linked.

I’ve also done a moderate amount of study with the Barral Institute, and am impressed to see them mentioned anywhere! It is interesting stuff.
posted by fizban at 1:32 PM on January 15, 2018

"“Oh, you’re having pain in your hands? Have you tried resting them?” Yeah, I’ll get right on that with a newborn."

I was having excruciating back pain that was leaving me in tears, complications of C-section, and I went to the doctor who said, "Well, you need to avoid lifting anything heavier than about two pounds. We don't like to give medication to breastfeeding mothers." "Uh, cool story, but as you noted, I'm breastfeeding, and the baby weighs nine and needs to be fed every two hours." "Well ... I'm sure it will improve."

FFFFFFFUUUUUUU
posted by Eyebrows McGee at 1:36 PM on January 15, 2018 [31 favorites]

Thanks for sharing. I’m pregnant with my first and being in the US I’m kind of terrified that this is going to break my body and my doctors either won’t care or won’t know what to do. My doc hasn’t said anything about diastasis recti and I have no idea what abdominal exercises are safe or not. I’ve defaulted to doing none which is also bad apparently per the article. Ugh!! It bothers me so much that we have very few studies on things that pertain to women’s health and pregnancy. Sometimes I feel like I should have moved to Europe and called it a day years ago.
posted by FireFountain at 2:01 PM on January 15, 2018 [4 favorites]

While it does sound like things are particularly shitty in the US, I am not surprised any ANY ob/gyn type conditions being "poorly-studied".
I think few women make it to 40 without having experienced some kind of condition that was shrugged off despite it being debilitating & treatable, or that they were never warned of, despite it being quite common. Start trawling through through Pubmed and you realise most people funding research don't give a shit about women's stuff, unless a treatment can be easily monetised (which obviously, physical therapy cannot).
I mean, I have personally experienced a whole list of these sorts of things and I consider myself to be pretty lucky compared to some of my friends.
posted by 8k at 9:21 PM on January 15, 2018 [1 favorite]

I am not surprised any ANY ob/gyn type conditions being "poorly-studied".

Reminds me of a discussion I saw somewhere else on birth-related injury and associated conditions, where someone suggested that the reason these don't get taken seriously is that female bodies are viewed as just inherently faulty. So when they start malfunctioning in painful/undignified/difficult ways, it's seen as an inevitability rather than a problem, no point really in looking into prevention or treatment or even what might be going on.
posted by Catseye at 2:11 AM on January 16, 2018 [10 favorites]

I would say, after my full-term and above-averagely sized baby that I had mild diastasis recti. I'm a small-framed person who also had a c-section so recovery was a bit long. It wasn't until nearly a year after giving birth that I felt like I could start back to regular movement and exercise. I took a yoga class geared towards moms (by the same teacher I took pre-natal yoga from) and she pointed out signs of the separation and then pointed out exercises that could help pull it together. Doing a little regular focus in this area helped me tremendously and quite quickly.

I do think that this is an issue in the U.S. that seems to be solved outside of your standard medical provider's office. Either through a mid-wives group, yoga practitioners (no, not all of them, look for ones that focus on birth and mothers), other alternative health groups. And it's such a simple thing to address (especially within that first year) that it's a crime that more women aren't getting education and treatment for this. Do a search in your local area and I bet you find someone holding a workshop or class on this. Even if you don't think you have it, if you were pregnant and are still feeling weak in your abs, I urge you to check in on this stuff. It's real good for you!

I'm 7 years post-partum and am taking a class from the same woman that is focused on core and pelvic floor. I kind of think this is something that you return to more than once.
posted by amanda at 11:20 AM on January 16, 2018

If you're interested in more, ProPublica's "Lost Mothers" series focuses on maternal morbidity and mortality in the US and is just an incredible read. Highlights include:

- The Last Person You'd Expect to Die in Childbirth
- ‘If You Hemorrhage, Don’t Clean Up’: Advice From Mothers Who Almost Died
- Why Giving Birth Is Safer in Britain Than in the U.S.
- How Many American Women Die From Causes Related to Pregnancy or Childbirth? No One Knows.
- Nothing Protects Black Women From Dying in Pregnancy and Childbirth
- How Hospitals Are Failing Black Mothers
- Severe Complications for Women During Childbirth Are Skyrocketing — and Could Often Be Prevented
posted by Ragini at 11:30 AM on January 16, 2018 [4 favorites]

Microchimerism: how pregnancy changes the mother’s very DNA. Women are chimeras, with genetic material from both their parents and children. Where does that leave individual identity?
posted by homunculus at 6:18 PM on January 18, 2018