DRA and Pregnancy: What You Need to Know

Diastasis Rectus Abdominus is an abnormal separation of the rectus abdominus (“6-pack”) muscles that occurs from excessive, repetitive force on the connective tissue of the abdominal wall.  While this condition is not unique to the pregnant individual, women who are pregnant are more vulnerable to this condition due to their hormonal environment combined with the excessive forward pressure being placed on the connective tissue from the growing uterus.  Some statistics report that 27% of women will have DRA in the 2nd trimester, 66% by the third trimester, and a recent study found 100% of women had DRA by 35 weeks pregnant.

You may be able to tell if you have this condition if you notice a “doming” around your belly button especially when going from laying down to sitting up or when bending backwards slightly while standing.  

To see how to test yourself for this condition, watch this short video: Testing For DRA

Typically when I encounter a pregnant mama with DRA, she’ll say one of the following things:

1. Yeah, I know I’ve got it but I plan to fix it after I’m done having kids.
2. What can I do about it now, after all I’m pregnant?
3. Diastasis what? I’ve never heard of it.

The misconception is that there’s little you can do for your midsection during a pregnancy, but I couldn’t agree less. There is much that can done to minimize the severity of this condition during a pregnancy as well as calculated decisions that can be made in the postpartum period to minimize the long term consequences.

It’s important to realize the effects of having a significant DRA in pregnancy.

The abdominal region is the only area of the body where there is connective tissue running directly down the center of the muscles.  This is not a flaw in the way that we, as women, were designed.  We were designed to birth babies so we need this connective tissue to widen to accommodate a growing uterus and fetus.  

It is less the pregnancy that presents the problem and more the way we sit, how long we sit, and the movements we choose to engage in during daily life and exercise that contribute to DRA.  If these muscles are allowed to separate to a significant degree during pregnancy, they can allow the heavier uterus to shift, leading to a more transverse position for the fetus.  This may cause altered labor patterns and will most certainly cause less effective pushing during a vaginal delivery.  Some midwives even bind women’s bellies during the pushing phase of labor to approximate the rectus abdominus muscles to make pushing more productive.

Things you can do in pregnancy to minimize DRA:

1. Utilize proper posture and alignment as shown here: Align Yourself Video
2. Avoid jack-knifing out of bed and learn the “sexy slide”: Sexy Slide Video
3. Choose exercises that focus on transversus abdominus and pelvic floor activation and relaxation.  Consider my online DRA class (contact me once purchased for a brief explanation of pregnancy modifications) or Prenatal Pilates class. 

Here’s what one birth-worker mama had to say about her experience with taking my DRA online class during her most recent pregnancy:

“Don’t wait to take this class! I waited too long to fix my diastasis (thinking I’ll get around to it) and than I got pregnant with baby number two. I went into that pregnancy with a weak core. I decided to take the DRA program when I was 20 weeks pregnant and so happy that I did. Although, I knew I wasn’t going to see my diastasis close going into my third trimester I did make a little improvement. The knowledge I gained, the exercises that we did, and learning to incorporate “nutritious movements” into my day allowed me to start strengthening my core. And postpartum I have a bag of tools and exercises to heal my body properly. I recommend Carrie’s program to all my students now. Every women, pregnant or not, should learn these important techniques to practice healthy exercise and movement.”  -Rachel Hudson (Childbirth Educator & Mama) 

The latest research shows that you have an 8 week “window” in which to spontaneously heal a DRA.  That doesn’t mean that you won’t be able to heal your separation after 8 weeks.  On the contrary, I have seen many women lessen the width of their separation and learn to generate tension in the connective tissue as much as 50 years post delivery!!!  It just means that beyond the 8 week “window” you will need to actively participate in some sort of recovery program.

Here are some things you can do in the first 8 weeks postpartum to maximize your recovery “window”:

1. Wear an abdominal binder as close to 24/7 as you can for the first 8 weeks.
2. Avoid jack-knifing out of bed and watch your body mechanics when caring for the baby (being careful to avoid twisting with heavy objects in your hand, limit time on all 4’s, watch your sitting posture when nursing/feeding your baby, limit time spent bent over the baby as when giving baths and changing diapers).
3. Allow your body time to heal before introducing exercise.  Start with a program that wakes up your deep abdominal and pelvic floor before adding more.  Consider my DRA online program. 

Most women I see make a full recovery after having DRA.  A very small percentage will require surgery (abdomioplasty), but I always recommend they start with the most conservative option first.  There is much to be learned about forces and body mechanics and finding your core that will be of value whether surgery is performed or not.  

Knowledge is power, Mamas, so start working on this condition as soon as you notice it!