What Is Diastasis Recti? Everything You Need To Know Prenatally & Postpartum.

Diastasis recti is the separation of your 6 pack abdominal muscles. It often occurs in pregnancy but can also occur in men from improper lifting and workout techniques. If the 6 pack abdominal muscles aren't able to expand as the baby grows, the small cartilage connecting the two sides can separate. It is measured in centimeters or fingers. It’s usually painless and can be fairly common occurring in ‘cross fit moms’. It’s why we don’t recommend crushes and sit ups in pregnancy. It’s also why we always recommend that you turn to one side and use your hands to help you sit up rather than lurching forward from laying back.

You can check if you have diastasis by laying down, lifting your head and shoulders to engage abs and feeling along the line of your 6 pack abs. 

If you have a separation, wearing a belly band and doing the belly pull exercises can help reduce the separation. It’s important to do so because the separation weakens your core and can cause low back pain and hip pain but also potentially a malpositioned asynclitic baby that could make labor more challenging. 

Separation is treated postpartum with targeted exercises to knit the abdominal muscles back together. Make sure to get the help of a specialized PT before you start your regular workout because you again want to make sure to avoid sit ups and crunches until the dialysis has healed.

Why We Don't Reccommend Lifting Weights In Pregnancy.

I don’t recommend weights because I frankly don’t think pregnant people need the additional weight. Their body is changing so much from week to week that just embracing those changes and working within that framework is challenging enough. The focus too often is only on strength rather than an equal focus on balance and flexibility. 

When it comes to strength training classes in pregnancy I’ve found that too many people have really bad form and posture (sometimes gets worse with lumbar lordosis) and develop hip and low back issues because they continue their same old work outs but haven’t taken into account how much more flexible their pelvis is and the additional weight from the baby. Even just in yoga I have to constantly make sure people are staying safe with their knees and back so adding weights to their routine gives me pause. 

For folks who have great posture, know what they're doing, have strength trained before they got pregnant and have good body awareness, it’s a personal choice. You have to do what feels right for you. 

Personally, I don’t think that using weights helps in your labor and birth, I actually think it can hinder the process which is why I don’t recommend using them prenatally. 

To expand - 

I like to compare birth to a marathon. When you know you’re going to run a marathon, you start building up your endurance and strength by running more. Each week you increase your distance by a little bit. It’s obviously going to be physically and emotionally challenging, but it can be a rewarding experience because it’s work that you’re doing for yourself. You can’t expect to show up to a marathon unprepared and hope that it’ll go well. A marathon lasts about 5 hours for most, labor is usually much longer. You don’t train for a marathon by doing a lot of yoga, it’s a totally different workout - so how can you start preparing for birth? 

You want to do everything you can to build strength and flexibility in the muscles that need it and will be used in labor. You want to make sure that you’ve practiced and are comfortable with the exact movements that you’re going to do in labor. 

From my perspective it means practicing diaphragmatic breathing, building endurance strength with squats and lunges (when you’re pregnant it's challenging enough with the changes in balance that I feel like weights aren’t necessary), building flexibility and strength in the pelvic floor with hip stretches and targeted transverse ab work that helps you stabilize and train for pushing while also allowing the belly to expand and grow. I’ve had many athletes and dancers who have have a lot of trouble finding that flexibility in letting the belly and pelvic floor expand - it’s so counter intuitive to our culture of 'sucking in’. They’ve always been taught to be strong and tight but not to release. It’s also hard to learn to let go and release in just 9 months after a lifetime of doing the opposite. 

In my opinion, not all exercises are appropriate prenatally even though all are ‘safe’. The few that do make labors longer are running, pilates, barre and spin because they create more tightness in your abdomen, hips and pelvic floor. They are also more energetically about squeezing, and pulling up and tightening at a time when you’re trying to expand, be more grounded and open. Pilates and barre specifically for any asymmetric poses tend to create hip pain and pubic symphysis pain because it takes a lot more to stabilize with growing belly and an influx of relaxin. Spin and running particularly for all the work that is required just to stabilize the pelvis is fine to do prenatally but a lot of people feel tightness in their abdomen after. Spinning is great to build endurance for labor but make sure to modify, have the handle bars up much higher, sit up straight stack your shoulders over hips. If you tend to have been a dancer or have a more toned pelvic floor, it may not be the best idea for you as it may add hours to labor and birth. So if you do spin, pilates barre or strength train, make sure to balance that with equal amounts or more yoga and other exercises to help build flexibility. 

Also in general cautioning for diastasis recti that weakens the abdominal muscles and risks having a mal-positioned asynclitic baby which again causes a longer labor. (It’s often those with a 6 pack before pregnancy) But all this to say that I think that a more toned pelvic floor and abdomen create longer labors and mal-positioned babies. That’s a big problem in the US because one of the major reasons for a c-section is ‘failure to progress’ so we’re not even given adequate time to let our body learn how to relax in labor. 

Obviously I know that 1 pound weights in a strength training series doesn’t cause the above but I’ve had so many people come to me feeling out of sorts in their back, hips, groin after other fitness classes and then feel much better after yoga. The PTs that I’ve worked with who specialize in prenatal/postnatal also only use body weight so I feel comfortable in my stance. 

The one thing that I do unequivocally endorse is swimming! It’s great because it’s no impact, builds stamina and encourages optimal positioning for baby. 

What Do People Wish They Had Been Told About Birth?

The most common things I hear from folks who come to my postnatal classes are that no-one told them about how common birth injuries and trauma can be and how to prevent them, how challenging breastfeeding is and how they could have never expected how hard it is to go back to work. 

The most important choice you will make is picking you care provider. I recommend not using someone just because they were your gynecologist, recommended by a friend or you like them personally. Make sure that they share and respect your point of view. Especially for those who are planning to try a non-intervention, un-medicated birth, you can do yoga, get a doula, take all the classes and be incredibly prepared but if you and your care provider don’t see eye to eye on electronic fetal monitoring, laboring at home, doulas, inductions, eating and drinking during labor, pushing techniques and positions it can not only create unexpected challenges and tension in your birth but also result in not being able to have the kind of birth you may want. 

Birth injuries in both vaginal and cesarian births are extremely common. It could be pelvic pain from a vaginal birth, headaches and spinal tenderness from an epidural or getting an infection from surgery. Another reason for why you want to be able to trust your care provider whole heartedly. Do you feel like you’re in good shape physically for this very physical and emotionally challenging event. I had one client tell me that she felt like she was in the best shape of her life just before she gave birth and completely prepared for the endurance needed for birth - that’s how I want you all to feel!

Breastfeeding support in hospitals are diminishing. Most clients only get about 5 minutes with a hospital lactation consultant. New parents go home with very little information, expecting things to go perfectly and they almost never do. Take a breastfeeding class prenatally and seek help from a lactation counselor as soon as possible. 

Many of my clients are high-powered, ambitious, career-oriented women. Most planned to take their maternity leave, usually about 3 to 4 months and then go back to work. About half of those who intend to go back to work have either extended their maternity leave by an additional 3 - 4 months and a few who have have quit their jobs. The shift and change in identity is hard to explain unless you go through it yourself. Be prepared and and expect as much as you can for the transition back to work to be challenging and hard. The easiest way to transition back to work is to do so slowly. If you are able negotiate to work from home, come in a few days a week or part-time before you go back to full time. Most people have found it easier to go back to work at around 6 - 9 months. I’m sure you’re already planning financially so something to take into consideration. 

Is It Okay To Sleep On My Right Side When I'm Pregnant?

The reason why pregnant people are asked only to lay on their left side is because of a condition that can occur called vena cava syndrome. Your vena cava, the vein that takes blood back to your heart is on the right side of your body and pressure from the uterus and baby when you’re laying back or on your right can sometimes constrict this vein causing breathlessness and nausea for you. Some people find it extremely uncomfortable to sleep on their back and others are okay. For the most part, being on your back or on the right side for a short amount of time is usually okay and fine to do.

Many people tell me they wake up in the middle of the night panicking that they’ve been on their back. If everything feels okay, you’re probably okay. Usually we wake up for a reason, it could be our body telling us to turn over or to go to the bathroom :) Listen and trust your body and your intuition and do what feels right for you. 

For stomach sleepers, it’s not safe to lay flat on your stomach however, you can fashion your snoogle into a circle around your belly and lay on top of it. You can also use half inflated pool floats or a maternity raft under your belly. Place a pillow under your ankles to ease any strain on your legs and low back. 

How Can I Naturally Induce Labor?

STIMULATE PRESSURE POINTS & INCREASE BLOOD FLOW

Acupuncture

Acupuncture can help more blood flow to your uterine muscles. Recommendations: Geneseed & Propper Acupuncture

Acupressure

Certain pressure points in our body can stimulate uterine contractions - the webbing between your thumb and your finger and two inches above your inner ankle on both feet. Massage with Clary Sage essential oil. The aroma is said to have contraction inducing properties. 

STIMULATE OXYTOCIN

Oxytocin, the love hormone, kickstarts labor and uterine contractions!

Nipple Stimulation

Nipple Stimulation helps to produce oxytocin. Manual nipple stimulation is great as well as using your breast pump for 10 minutes of each side a few times a day can help!

Sex 

Sex not only stimulates the production of oxytocin but if you have a male partner, prostaglandins in semen can help soften the cervix.

MOVE

Walking & Climbing Stairs

Walking helps to open your pelvis and the more you move, the more you allow baby to move and descend into your pelvis. Climbing stairs is another great way to help open your pelvis and encourage baby to move.

Spinning Babies

These movements can help loosen ligaments, reset your pelvis and encourage baby to shift position

Forward Leaning Inversion

Rebozo Sifting

Side lying Sacral Release

Squats, Pelvic Circles, Figure 8s, Swaying your hips from side to side

Think of your pelvis as a sieve. In order for baby to move down, movement from side to side can help!

Bounce on a Yoga Ball 

Bring movement to your baby and encourage them to lower into your pelvis! Check out this mom!

Dance!

I’ve heard that belly dancing came to be to help encourage labor. i’m not sure if there’s any truth to that rumor but moving your hips certainly can’t hurt!

EMPTY YOUR BOWELS & BLADDER

Create more space for baby to move down and stimulate uterine contractions

Castor Oil

Ingesting one tablespoon of castor oil (a natural laxative) mixed with 4 ounces of orange juice to dilute can help. Can cause diarrhea so please stay hydrated!

Enema 

If you have done at home enema’s before, it can help to empty your bowels and stimulate contractions. I would not recommend this unless you’ve done this before!

EAT & DRINK

Drink

Lots of fluids, empty your bladder often. Raspberry Leaf tea is known to help uterine contractions. We instinctively release our pelvic floor in the bathroom and know to let go. 

Eat

Pineapple, Papaya, Black Licorice (Panda Brand) to stimulate the production of prostaglandins. Spicy food can also help empty your bowels. 

Evening Primrose oil

Can be applied on the perineum or ingested in pill form can help to release prostaglandins.

RELAX

Sometimes, our mind can get in the way. We’re so used to planning and having a schedule that when confronted with an experience that we can’t fully control can lead to stress and worry. The exact opposite of the warm cuddly oxytocin feelings that can help labor. Take a bath, meditate, get a massage whatever helps you relax and let go.

OTHER OPTIONS

Stripping Membranes

This is a procedure where a medical professional manually separated the bag of waters from the cervix to stimulate the release of prostaglandins. Check with your care provider if this is right for you. If you’re scheduled for an induction, asking for this procedure a few days prior may cause labor to start spontaneously. 

METHODS OF INDUCTION

Balloon Catheter

An instrument that is inserted in the cervix and manually helps dilatation. It stays in the cervix until it is able to easily be removed when dilation reaches bout 5cms. It can be uncomfortable but allows you not to take medications. 

Prostaglandin Gels

Such as Cervadil are inserted in the cervix. They can cause nausea and abdominal cramps

Pitocin

Artificial oxytocin delivered via IV. Usually used as a last resort to induce labor, once you are on Pitocin, you are required to be monitored on the Electronic Fetal Monitor at all times and contractions via Pitocin can be quite painful leading many to get an epidural. You can also read about the side effects of Pitocin here. Without the epidural however, you can still move and walk for pain relief. To avoid labor stalling early on I recommend using your natural pain management techniques for as long as you can, if the contractions become unbearable or you really need to rest, then an epidural is helpful. Know what to expect from an epidural here

Artificial Rupture of Membranes

This is called breaking your water and it’s usually done by a medical professional with an amnihook. Also only recommended as a last resort, once contractions are well under way. Once your water is broken, often you’re put on a time clock and the baby must be born within 24 hours or so. You are also more prone to infections if the water has broken. 

What Do I Need To Know About Getting An Epidural?

What can you expect from the procedure should you choose to undergo an epidural for pain relief during labor? When is the best time to ask for it? What positions can you be in? How long does it take to work? How long will it last?

I’m also introducing a concept called the Gate Control Theory of Pain, which explains how we can most effectively manage pain in childbirth with natural alternatives. This goes hand in hand with the idea that rather than fearing the pain of labor and delivery, by being informed and prepared, we can embrace the physical challenge for better experiences and outcomes.

  • An Epidural is spinal anesthesia offered to you at the Birth Center or Hospital.
  • Epidural medications fall into a class of drugs called local anesthetics, which includes bupivacaine, chloroprocaine, and lidocaine among others. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. 1
  • An epidural can take time to be administered depending on the availability of the anesthesiologist. Just keep in mind that you may not get it the minute you ask for it; there can be a bit of a wait–anywhere from 15 min to 2 hours. Plan to cope with a potential wait using breathing, massage and relaxation techniques.
  • After a local anesthetic is administered, a catheter delivering the medication is placed in your lower spine.
  • You’ll start to feel the effects of the medication in 15 minutes or so. After it’s turned off, these effects will wear off in an hour or two.
  • You will not be allowed to leave the bed; however, you will be able turn on your side and use a peanut ball between your legs. 2
  • Since you won’t be able to get up to go to the bathroom, a urinary catheter will be inserted as well. They’ll put it in once you’re numb and take it out before you push.
  • Whether you have an epidural or not, most hospitals and birth centers will require you to have an IV, usually inserted in your non-dominant arm. If you choose not to have an epidural, you can ask for a hep-lock instead so you don’t have to carry the IV bag around with you. However, if you get an epidural, a continuous IV will be placed.
  • The fetal monitor is essentially two discs that are placed on your belly to help record the baby’s heart rate and monitor your contractions. It significantly limits your mobility. If you choose not to have an epidural, you may ask for intermittent fetal monitoring. However, in the case of an epidural, continuous electronic fetal monitoring is necessary. Studies have shown that there is no difference in birth outcomes between continuous and intermittent fetal monitoring and continuous fetal monitoring is associated with a greater chance of cesarian section. 3
  • You can ask for the button to control your own epidural medication. Studies have shown that when self-medicated, women give themselves smaller dosages! 4
  • Labor will likely slow down when you get an epidural. If labor does not progress, pitocin may be introduced to augment labor. 1
  • Occasionally, the epidural will be uneven, with more feeling in one leg or the other. Let your care provider know as soon as possible if that is the case. 5
  • Our recommendation si to wait until you are 6- 7cm dilated to get the epidural. Getting the epidural too early can stall labor. Once you’re at 8cm, you’re so close that it may not make sense unless it's been a really long labor and you're looking to rest. 
  • Occasionally, some women are allergic to the medication. There isn’t a good way to test for this allergy, but you can ask for it to be administered in small test doses to start. 6
  • Studies have shown that epidurals can cause maternal fevers and in turn affect the baby. If you have a fever after birth, often the baby is taken to the NICU for 48 hours to ensure that they haven't developed any infections. 7
  • There is a risk for pelvic and hip injuries caused when pushing. Injury can occur both with an epidural and without but not being able to fully feel your internal musculature can put you at a greater risk. 
  • The medications in an epidural are the same as those used for anesthesia in Cesarian sections. In case of a C-section, the epidural is left in for about a day to help numb the pain after surgery. You will be given pain meds after the epidural is taken out, and the scar from the incision will be kept numb for a few weeks.

The Gate Control Theory of Pain–A natural alternative to relieve pain

Have you ever burned your finger and immediately run it under cold water for relief? The Gate Control Theory of Pain explains that there are two types of fibers that transmit messages to the brain–slow-acting fibers, and fast-acting fibers. However, before the pain signals reach the brain, they encounter neurological “gates” along the spinal cord. These gates filter pain signals to determine which ones reach the brain. Pain is perceived when the gates give way to these signals, and is less intense when the gates close. If the fast fibers are stimulated more than the slow fibers, the gates close, inhibiting transmission of pain impulses and reducing pain perception. So when we pour cold water over a burn, the water activates the fast acting fibers which closes the gates, which results in fewer pain impulses reaching the brain and reduces our perception of the pain from the burn.

When we apply sensory stimulation–such as heat, cold, water in a bath/shower, firm pressure, intradermal water blocks, Transcutaneous electrical Nerve Stimulation (TENS) and massage–the fast fibers are activated, endorphins are released, and the transmission of pain never reaches the brain, preventing us from perceiving it.

So while waiting for the epidural (if you choose to have one), to manage your pain most effectively use methods that take advantage of the Gate Control Theory of Pain. For example, place a heat pack on your low back in the same spot where an epidural would be administered, or have someone massage you in that same spot. You can see exactly where on your lower back an epidural is administered at this link.