Practical Advice: Post Natal Stomach Muscle Separation

Many women's stomach muscles become separated whilst they are pregnant and in most cases the muscles can go back together, without need for any medical intervention, so don't panic if you fear that yours are separated. 

First of all : how do I know if my stomach muscles have separated?

Lie on your back, feet planted on the floor by your bottom. Lift your head up and put your fingers into the midline of the stomach. If the fingers dip in, you have separation. In the picture below you can see that I don't have separated muscles (any more) at the top, but they are separated at the bottom by my belly button. *

Secondly, what can you do about it? 

I am not a doctor or physio, but have read quite widely around the subject. With careful management, many stomach muscles will gradually come back together without the need for surgery.  The focus is on exercises that draw the muscles together, rather than pulling the two sides apart. Sit ups, for example, tend to pull the two sides apart. As does boat pose. Over-opening of the torso in upward dog or bow pose can also be considered unhelpful. 

Helpful exercises include :

1. Cat / Cow stretch. From an all fours position, exhale, draw your stomach back towards the spine and arch your back like an angry cat. Inhale, flatten the back down. Repeat x5.

2. Heel Slides. See here

3. Leg Lifts. See here. 

4. Heel Taps. See here 

5. Pelvic Tilts. Either lying on the floor with feet pressed into the floor by your bottom or standing against the wall with knees slightly bent, exhale and bring your lower back towards the wall or floor. Inhale to relax, repeat again.

6. Head Lifts. Lying on the floor with feet pressed into the floor by your bottom, inhale to prepare and exhale lift your head up. Inhale release your head to the floor. Note you're just lifting the head, not your shoulders. This is not a sit up!

7. Squats against a wall, ideally with a block or small ball between the thighs. 

8. Bridge - with leg lift.

9. Side Planks (normal planks are potentially unhelpful, particularly if held). A side plank with knees on the mat is a great place to start if you're rebuilding your strength.

*You may well ask, if I'm following my own advice, why are my stomach muscles still separated? Well, first of all my youngest child is only 18 months old and it can take years for muscles to fully go back together. There is a much smaller separation than there was a year ago. Secondly, I have had several umbilical hernias and in the place in the photo where I have separation, I have a mesh repair behind it. The doctor advised me that my hernia would still be visible after the repair, but it would be safe. I therefore am assuming that my separation may be visible but not important. But I'm not a doctor. Please check with yours if you're concerned.

Mother and Baby Yoga

I held the first of my new series of Mother and Baby Yoga classes today at the lovely private studio in Claygate and it was lovely to see mums who I saw through pregnancy return to yoga with their little people. 

Abdominal Muscle Separation is very common during and after pregnancy and as this is a post natal class, of course I not only ensure it's safe to do, but also helpful.

Some reminders of things you can do at home, if you wish, to support your stomach coming back together are as follows:

1) Reverse Breathing. 

Not as complicated as it sounds! Sit in a comfortable position, baby on your lap or on the mat in front of you. Sit up tall, shoulders away from the ears. Inhale, lifting up the pelvic floor, then exhale and pull the tummy in, all around, as though you were wearing a corset. It's very much a wrap the tummy in and around action, rather than a flatten-your-lower-back action. 

2) Holding your core when moving

Whenever you stand up, sit down and especially when you are picking up your baby, hold your core inwards, try to keep the back straight and bend your knees. 

3) Heel slides

Lie on your back, head on a cushion. Bend your knees and place your heels by your bottom. Inhale straighten one leg, exhale slide the heel along the floor back towards your bottom, inhale and slide the heel out again. You may find it easiest if you have socks on a wooden floor, for example, for slippiness.  Focus on the exhale and the tummy wrapping round and in as you bring the heel towards you.