Diastasis Rectus Abdominus, or DRA for those of us short on time(!), is an abnormal separation of the left and right rectus abdominus muscles and can happen in babies, athletes, men, and women! Having a history of being pregnant (no matter the delivery method) can put you at increased risk for this condition for several reasons.
The abdominal region is the only area where connective tissue runs directly down a muscle group’s center. This is not a flaw in the way we were designed, ladies, but rather a miracle of nature designed to allow our bodies to accommodate a growing baby and uterus. That being said, the extra force placed on this vulnerable tissue by the uterus may increase our chances of developing a DRA. Some of this is out of our control, but we can control how we align our bodies in pregnancy to minimize this pressure. Don’t allow yourself to “hang on your ligaments” as you thrust your pelvis forward in pregnancy. How will you know you are doing this? You’ll most likely have a constant wet spot on your clothes near your pelvis because instead of using counters to support your work, you may use the counters in your home to support your body. When brushing your teeth, take one step away from the sink and make your body hold itself up. When washing dishes, take one step away from the counter and make your body hold itself up. You’re already getting enough pressure on the connective tissue from the baby, so start making your body do the work it was designed to do!
You have three layers of abdominal muscles. The most superficial muscles are your rectus abdominus or “6-pack” muscles as they are affectionately coined. Next come internal and external obliques. All three of these are registered as a very loud voice in your brain, and traditional abdominal exercises often take an already “loud” muscle and make it a scream! Meanwhile, your deepest abdominal muscle, your transversus abdominus, is registered as a whisper in your brain, and the extra stretch of pregnancy can turn it into a muted voice altogether. The transversus abdominus is responsible for compressing your viscera and stabilizing your spine. Without it working properly, it’s no wonder you may feel disconnected and be left with back pain. The key here is balance!
In pregnancy, you have increased levels of progesterone and relaxin working to soften and relax all the connective tissue and smooth muscles in the body, not just those around your pelvis. This means that the connective tissue between the rectus abdominus muscles (the linea alba mentioned above) will be affected by these circulating hormones. It should also be noted that the stress hormone cortisol, when present in abundance, can also weaken connective tissue. I’m not sure I can find a pregnant or recently postpartum woman on this planet who isn’t experiencing an elevation in her stress levels.
Many women are extra motivated to stay fit during their pregnancy. They may inadvertently choose an exercise program not designed by a skilled Prenatal Specialist who considers the above risks. Women should avoid any movements where they cannot properly manage the pressure in their midsection (most often, exercises like crunches, cross-overs, weighted twisting, and double leg lowering should be avoided). Excessive time in all 4’s positions may harm a vulnerable midsection more than good. Notice I included movement here, too, because the way a pregnant woman positions her body in sitting, standing, lying down, and with her activities of daily living may be setting her up for abdominal separation.
If a woman is experiencing a longer second stage of labor, especially if she is pushing in the dorsal lithotomy position (on her back with knees up), it is essential that she knows how to activate her deeper abdominals. Spending loads of time here can create a separation or worsen one already present before labor.
In those tender first few months after giving birth, your body is looking for guidance from you as to where all its parts belong. Jack-knifing out of bed ten times a night to check on a noisy newborn or nursing in a half-collapsed position of exhaustion will give your fascial structures the wrong message about where they should be. Likewise, asking your postpartum body to tote a stroller, car seat, diaper bag, and baby all at once or joining an intense Boot Camp Class is setting the stage to allow excessive intra-abdominal pressure to make a grand escape through the path of least resistance (often by bulging out through your midsection or maybe down below through the pelvic floor in the form of urinary incontinence or pelvic organ prolapse).
Let me reiterate that our bodies were designed to birth a baby, but there are choices we can make along the way that will allow us a better chance of raising that baby with confidence and without a bulging belly or leaky pelvic floor.