Why isn’t my stomach flat after pregnancy?

This is one of the most-asked questions I get as a Women’s Health PT and Postnatal Pilates Specialist. 

It’s a question I vividly remember asking myself one week after the birth of my first child when my once flat stomach bubbled up to the surface of the water as I attempted to relax in the tub.  I poked at this flabby skin pouch with a mixture of confusion and fascination.  The body I had once known and had grown to love over the first 28 years of my life (especially as it grew my child for the last ten months) was…..different…..changed……new, and I quickly realized I would need to make peace with this stranger, more fluid part of myself if I was going to be at peace in my body.

The way our midsections will look after birth is due in large part to genetics.  And this sucks because it’s completely beyond our control.  Some women have collagen that stretches and miraculously finds its way back to its pre-pregnancy configuration, while most of us have collagen that stretches and flounders a bit.  Also important is how many pregnancies you have had and how much weight you gained with each pregnancy because this means your connective tissue has had to stretch and retract more than a woman who had one pregnancy and gained a small basketball in size.

But your current posture and alignment can play a role too.  Finding a neutral pelvic position and ensuring your rib cage is not flared up or down means putting all the muscles of your core at their most optimal length-tension relationship.  Not only is this the first part of strengthening your core, but it results in a more flattering posture than if you “hang” on your ligaments and let everything “spill” out in front of you.

So what does this look like in standing?

Start with your feet and make sure your toes are pointed straight ahead (no duck feet here!).

Rock your weight into the heels of your feet so there is very little pressure under your toes. It may feel like you are falling backward because some of us have been “gripping the world” with our toes.

Next, work your way up to your knees. Your knees should be straight BUT NOT LOCKED. In fact, you should be able to contract your quadriceps muscle to move your kneecap around a bit, which is impossible if your knees are locked straight. Did you know you have something called a knee pit? It’s like your armpit, but it’s directly behind your knee. Your knee pit should be facing straight back, not angled to the outskirts of your room. Some people may need to roll their thighs outward an inch or two to put their knee pits directly behind them. Not only will this alleviate some pressure on your medial knee joint, but you should feel your butt muscles turn “on,” meaning you’re getting some activity back there just from standing in better alignment; yippee!!!

Work your way up to your pelvis. Your pelvis should be in what we call a “Goldilocks” position….not too tucked, not too arched, but just right. It’s roughly a position where your front pelvic bones (called your anterior superior iliac spines) are flush with your pubic bones.

Now on to your rib cage. Your ribs are like a bell that swings off your shoulder. We don’t want a bell rung up or down but rather a quiet bell stacked directly over your neutral pelvis. Another way to think about it is if you had pencils shooting off the end of your nipples, we wouldn’t want them pointing up like skylights or drooping down; we want them pointing straight ahead. (FYI, if you’re not wearing a bra, all bets are off on that last one!

Lastly, if you have a diastasis rectus abdominus (DRA), which is an abnormal separation between the left and right rectus abdominus muscles, there is a chance that excessive intra-abdominal pressure may cause your organs to “pooch” into this region, giving the appearance of the dreaded “mummy tummy” or “beer belly.”  While unflattering in an aesthetic sense, there are true health concerns with having a muscle separation that may include alterations in bladder/bowel function, digestive issues, urinary incontinence, pelvic organ prolapse, and low back pain. 

Thankfully, this condition can be prevented with the right information, and it can often be rehabilitated with a quality program combining education and exercise. Our goal should not be the flat stomach we remember from our pre-pregnancy days but rather a strong core that supports our movements and exercise for the rest of our lives.  You spent a long time learning to love your old body, and I give you permission to mourn for a moment.  But then it’s time to pick yourselves up by the bootstraps, Mamas, and build yourself a body you will love until the end of time!