Posts

I get asked about swimming quite a bit, mainly whether it’s safe when you have diastasis recti, but I’m going to cover pregnancy as well as postnatal here, so I’ll start with that.

Swimming During Pregnancy

 

Swimming can provide relief from aches and pains often experienced during pregnancy, relieving the pressure of your bump by supporting it, and taking the strain off your back.

It’s also great for improving your circulation which is sometimes affected during pregnancy, because of all of the hormones running around your system.  The pressure of the water on your veins and arteries actually stimulates blood flow and can reduce swelling you may be experiencing, say in the feet or ankles.

A workout and relaxation all in one!

 

A trip to the pool also gives your muscles a great workout!  Water offers 12 times the resistance of air, and your deep abdominal muscles get in on the act too, as they help stabilise the pelvis in water.

The rhythmic action of the stroke can also be quite relaxing, as can the feeling of weightlessness.  For baby, the soft muffled sounds created by the water induce a feeling of calm and tranquility for him/her too.

Which stroke is best?

If you are experiencing any pelvic pain during pregnancy, I’d suggest that you avoid breast stroke leg action.  Even if you don’t suffer with SPD now, I’d be mindful of how you feel, and avoid kicking too hard/ agressively. Keep the kick narrow, and avoid a wide ‘froggy’ breast stroke kick.

I personally found freestyle/crawl a lot more comfrotable when pregnant, but I know not everyone is confident with this, and it can be quite tiring.

As a guide, on a scale of 1-10, you shouldn’t exert yourself above a 7 when pregnant. This means out of breath, but not uncomfortable: you should still be able to talk and hold a converstation (albeit a panting one)!

I’d also recommend buying a pair of goggles so you can swim with your head down, because this puts less pressure on your back.  Swimming with your head out of the water causes the pelvis to drop and accentuates the increased curve in the lumbar spine.

Swimming With Diastasis Recti

 

Ok, postnatal now. The question isn’t so much “is it safe”, as unless you have pelvic pain or a back problem, the risk of injury is low. It’s more can it worsen your diastasis, or prevent it from healing?

Firstly, people worry that being horizontal could put a downwards pressure on the abdominal wall. However water creates a hydrostatic pressure, and when you’re horizontal in the water the pressure from the water below (which helps give you buoyancy) will apply some compression to the abdomen.

There’s more to consider though, and your alignment in the water (or your technique) is really important too. If you have your head out of the water the whole time, then you’re arching your back (which may be sore) and stretching your abs. It flares out the ribs, which I see a lot in postnatal mums and you’re better off avoiding.

Let’s look at the 2 most popular strokes.

Breast Stroke

So if you’re going to swim breast stroke, head down (as in looking at the swimming pool floor) and in the water with each stroke! I can’t really go into technique much here, but if you watch Michael Phelps here, he actually keeps his back fairly neutral. Most of us don’t manage quite such a neat stroke though!

Also- if you still have any pelvic pain, the points above apply and I’d avoid breast stroke.

Front Crawl

I still find there can still be a flaring of the ribs, as when I swim in busy lanes I have to look up to see if anyone is in front of me. This arches my back a little and flares my ribs. I have to be VERY mindful of my technique to avoid it- again keep your gaze on the pool floor. Let’s look at Phelps again (may as well learn from the best!) and see how flat his body and spine is.

Keeping your hips up and kicking from the hips, using the butt muscles (instead of kicking from the knees) helps too, with both speed and glute strength (important for a healthy pelvic floor).

I also have to focus to keep my shoulders relaxed, and not up around my ears! Tight neck/ shoulders is common with my clients, so you don’t want to make that worse.

Core Strength and Shoulder Mobility

 

You also need to consider your flexibility. Lie down and reach your arms in the air.

swimming postnatal exercise watford
Then let them fall behind you.
swimming postnatal diastasis watford

Does your back arch and ribs flare out (as I nicely demonstrate and highlight with my snazzy editing skills)? If so then there’s a good chance that when you swim and reach in front, you’re doing this too.

If you engage your core can you lift your arms without arching your back (again demonstrated by me below- my ribs have dropped down and my back has a gentle curve,rather than a larger arch)?

swimming postnatal engage core

You need to engage your core to do this. Be honest with yourself, can you do this while you’re swimming? You might be better off working on increasing your core control before you get back in the pool.

The other thing that might be in issue is shoulder mobility. If your arms won’t fully reach up or flop to the side, you may need to increase your flexibility in that area first too.

postnatal swimming watford personal trainer

Breathing

No breath holding (this applies to pregnancy too). When your head is under water exhale, then inhale when out. Holding your breath places pressure on the core and floor.

Core Connection

If you’ve done some postnatal core training and can engage your deep core and breathe diaphragmatically, then that really will help. Personally I would work on that postnatally before getting in the pool. This way you’re controlling your core, controlling your spine and rib position, and minimising any pressure on your diastasis.
Swimming is a very repetitive movement, and you don’t want to be doing it in a way that repeatedly puts pressure on a tummy that needs to heal.

The Take Home

Swimming isn’t necessarily bad for diastasis, but it depends on your technique!

Ultimately, if you feel swimming makes you feel a bit human again, gives you some time out, and you feel better for it, then GO FOR IT!

BUT, if you have a large diastasis, or one that isn’t healing, maybe consider this could be a factor. Think about your technique, and it might be that you need to take a break for a bit whilst you work on restoring it.

I’ve written before about returning to exercise post C-section, but I didn’t touch on one important area of C-section recovery: the scar. Because I think this deserves a blog of its own.

I meet a lot of C-section mamas, and issues such as poor sensation/numbness, ongoing pain and a feeling of tightness in the area are common. Which is hardly surprising: even from a small cut I’ve felt tightness in the area as it’s healed.

But this rarely gets talked about- why not?! There’s been trauma to muscles, nerves, blood vessels, right in the hugely important area of the abdomen no less. Your core muscles (we want those functioning well, right?) and a number of organs are potentially affected by this. And massage can make a huge difference to the healing process.

So why aren’t all C-section mamas told to massage their scars as part of their recovery?

 

Advice is all about the appearance of the scar, such as looking for signs of infection, yet the effects of your C-section can go beyond what you feel in the scar itself.

This may sound severe, but remember the scar is far deeper than what we can see: if you think about how deep the incisions are, and how scar tissue is formed, this isn’t surprising.

After surgery scar tissue forms as part of the healing process, but the fibres go in all different directions, can feel tighter, and it can adhere to other tissues, such as skin, muscles and even organs. This is when problems can occur.

You can view a video here of what these adhesions look like.

So what issues can arise?

Low Back and Pelvic Pain

Adhesions in this area can affect the sacrum, which is where your spine meets your pelvis, so anything that interferes with its movement or function can have a knock on affect to your low back too.

Frequent urination

I think this one is self-explanatory! You should be urinating every 2-5 hours, but many women find themselves having to dash to the toilet far more often. Again adhesions in the area can affect the bladder’s expansion and sensitivity, interfering with normal function.

Pain with intercourse

This comes back to adhesions around the organs again: if it limits their movement, then they can’t get out of the way during intercourse, which can be very painful.

Obviously not every woman who’s had a C-section will experience these symptoms. But it’s worth knowing about because sometimes it can be years before any issues occur, as adhesions continue to form. And while massage won’t prevent all of this, it can definitely reduce the risk and severity of symptoms should they occur. So you’ve got nothing to lose from trying it!

So how do I massage my scar?

When to start:

Ideally as soon as it’s fully healed to prevent the formation of deeper adhesions. But it’s never too late to start, even years later!

How often:

More regularly to start, when the tissues might not be moving very freely, but once they are it’s still a good idea to revisit it once every so often, in case it’s getting tight again.

If you have difficulties doing this or notice your tissues don’t seem to be responding to your efforts, then you should see a Women’s Health Physiotherapist for treatment.

How?

This is the best video I’ve seen of how to massage your scar, by Lynne Schulte at Intuitive Hands PT.

However there are also therapists who specialises in scar tissue massage. Emma Holly from ScarWork at Restore Therapy told me about a recent client and how scar massage helped her:

After a long labour she ended up with an emergency c-section. After a few months she started to try some exercise videos and found she had bladder weakness and sought out an amazing women’s health physiotherapist and has started a course of exercise to strengthen her pelvic floor.

Her c-section scar had left her with little feeling and a disconnect with the pelvic area. She came to me for treatment where I worked along the scar tissue, using ScarWork therapy to stimulate further healing. Deep stretches loosened some adhesions caused by surgery and using massage to release the pelvis and hips post pregnancy.

After one 45 minute session she walked out of the appointment and said “oh, my hips feel different” in the days that followed she noticed her feeling of the pelvic floor improved so she could be more aware when drawing up the muscles and is now finding her exercises from the physiotherapist and in restorative pilates much easier.”

In addition, if you are having any issues with pelvic pain, or that might be associated with adhesions to your organs (including bowel problems) many Women’s Health Physios are trained in visceral manipulation, so can assess you and work deeper than you might be comfortable doing yourself.

WH Physio Becky Aston explains how this can affect breathing patterns (read this blog for more on the breath and core strength) and result in pain elsewhere:

 

An amazing fact about the diapraghm (muscle below the lungs) is it moves up and down 20,000 times a day. We think of the ovaries, kidneys, liver, pancreas etc just existing in our pelvic and abdominal cavity but they move in a synchronised fashion with the diaphragm.

Now imagine that you have something restricting this movement i.e. adhesions from a scar. However small, they will limit this movement and other structures will have to accommodate. This can cause pain or dysfunction anywhere else in the body.

Releasing abdominal adhesions can relieve IBS symptoms, menstrual pain, back pain, help the pelvic floor muscle and deep core work more effectively and many more things.

Visceral release work is a gentle therapy with mobilises visceral and myofascial structures which can release those adhesions and allow the body to be synchronised again.

And finally…

A note on numbness and loss of sensation in scars, as this is what I most commonly get asked about.

Nerve damage can be permanent, but nerves do regenerate. The speed of this is slow though, about a mm a day (it depends a bit on the size of the nerve in question) so it can take months and even years to regain feeling. The same goes for feeling such as tingling or itchiness.

I find that the impact of a scar can reach far beyond its immediate area. Tight quad muscles (on the front of the thighs) for example can pull on the scar, so massage and release work here can be beneficial to the C-section mama. And any scar can have a huge impact on muscle function too.

If you’re interested in booking a postnatal massage with me to help with your recovery, and with your scar massage, you can find out more about what it involves here.

And if you’re one of the many women who finds the thought of touching your scar makes you feel ill, you’re not alone. The comments I received after first writing this blog prompted me to write a second about scar aversion. You can read it here.

 

I think every client who comes to me wants a stronger core, and this is where we start. It really is a simple step. Or at least it sounds simple. In reality, it can be pretty hard to master, at least when you’ve just grown a baby!

I’m talking about breathing correctly.

Correct breathing technique is one of the tips in my guide to kick-starting your postnatal fitness, and it’s one of the first things I look at with postnatal clients, before starting any exercises even.

It might seem silly, and you’re thinking “but I feel so weak- I need to get working, feel my muscles again!”

And I get that. But if you don’t get the breath right, you won’t be getting the most out of your exercises.

Let’s start with the core itself.

I’ve explained it in this video, and if you look at the image below, you can see how the muscles of the abdominal wall and the back form a cylinder, with the diaphragm (that’s the main muscle used for breathing) at the top, and the pelvic floor at the bottom.

postnatal fitness

These four elements work together, and when one isn’t functioning properly, it affects the rest of the team.

Before you read any further, try something for me: place one hand on your ribs, thumb to the back and fingers to the front, and the other hand on your tummy. Take a few breaths- what can you feel moving, what’s happening?

Here’s how they should be working together.

postnatal core fitness

As you inhale, the diaphragm moves down, the pelvic floor lengthens, and the abdominal wall (and trunk in general, the low back opens up as well, which isn’t shown here) expands. The rib cage opens up in a 360 degree action too.

Here are the ribs in action:

You should hopefully feel a softening of the tummy and pelvic floor as this happens.

As you exhale the diaphragm rises, and the pelvic floor and abdominal wall naturally tension. You may even feel your low back joining in on a more forceful long exhalation.

How is this relevant to getting a flatter/ stronger tummy?

 

Because so many people have poor breathing technique. Especially new mums. Having your tummy muscles stretched and a baby’s butt pushing into your diaphragm for months will do that. Here are a few of the problems that I come across.

Mistake Number 1- Belly Breathing and Diastasis.

 

Diastasis Recti is when your abdominal muscles stretch apart during pregnancy. Once the baby is gone and the pressure stretching them removed, they should move back together again over the next few months.

But sometimes the pressure isn’t removed. If you’re a belly breather (think BIG expansion of your tummy every time you inhale) then that’s pushing on your diastasis every time you take a breath. Which is about 20,000 times a day. Not good.

Mistake Number 2- Sucking It In.

Holding in the abs. How many of us are guilty of that? In a world where we’re continually informed that a flat tummy and six pack= sexy, it’s tempting to do!

But if your tummy’s sucked in, where’s that pressure going? Down on your pelvic floor, or up on your diaphragm. The whole mechanics of your core is altered.

Strong abs do NOT = functional. You need them to be able to move with the breath. Permanent tension is not practical, and can result in back ache as your low back muscles over work too.

So let it go!

Had to be done!

Mistake Number 3- Shallow Or Chest Breathing.

 

Booby breaths as I like to call them. Think heaving bosoms in corsets. This often goes hand in hand with the sucking in, but many take heavy chest breaths, where the ribs go up as you breath, rather than out. It’s usually a tense and shallow breath, which means the core will not be effectively loading and unloading, so not making the most of your exercises. And think how relaxing a good deep breath is- you’re not getting that release if you’re stuck shallow breathing! If you’re shoulders rise when you breathe in- you’re doing it wrong! Remember- 360 expansion.

Now let’s try connecting to your deep core as you breathe.

 

With one hand on your tummy, one on your ribs, inhale, and try and feel a 360 degree softening in your belly and your ribs open up to the sides. Feel your pelvic floor soften and lengthen.

Now exhale for an 8 count, like blowing bubbles (I get the Restore My Core mums to actually do this!)- can you feel a tensioning in your tummy and hopefully pelvic floor?

personal training core

You might only feel your chest at first. After giving birth, regardless of the type of delivery, nerves can be affected, so this, plus the load carrying a baby placed on you, means this connection to the breath can be lost.

Bring your attention to your tummy and pelvic floor, and take your time.

Here’s a live facebook video I did on this, exaplining how you can practise correct breathing technique (it’s live so forgve me for forgetting to mention- as you inhale try to feel your pelvic floor lengthen, and rise as you exhale):

It takes practise, and there are also certain releases (such as massage, or some self applied techniques that I teach on Restore My Core) that I find very effective in helping to release and open up the rib cage and low back.

Hopefully you can see that even if you do the best exercises in the world to heal a diastasis, if your breath is putting pressure on your abdominal wall all day long, they won’t be effective.

To get a strong core you HAVE to start with the deep muscles. Once they are well co-ordinated, THEN you can start working on your abs.

But only when the inner unit is stabilised! Which means the diaphragm, pelvic floor and deep core working together on every breath.

Once you’ve got the hang of this head to this blog for some postnatal core exercises to get started on, and you can also download my 10 Tips for getting back in shape after having a baby.

The 6 week postnatal check- that’s when you get the all clear and it’s back to business as usual, right?

That’s how I remember feeling anyway, and from my experience training new mums, I know I’m not alone.

I remember sitting there and asking, “So I’m ok to go back to exercise now?”

And I got lucky, because my GP said yes, but advised that giving birth means my body had been through some big changes, and 3 months would be better, to really have time to recover.

That, plus having a baby who didn’t sleep well, plus geting mastitis at 3 months postpartum, meant that I didn’t get back to training as quickly as I had planned. Which probably saved me from doing myself some harm.

Because although I’d been a personal trainer for 7 years, I didn’t have any postnatal qualifications at that point, and the general message I’d absorbed from the media is that if you’re in good shape you should ‘bounce back’.

And I was fit, so I should be fine. In fact, because I worked in the fitness industry I felt I should be seen to recover and get my fitness back quickly, and I was very fortunate to have a doctor who gave me some good advice (and to be too exhausted to argue with it)!

Because The 6 Week Postnatal Check Does Not Mean You’re Ready To Exercise!

However, this hinges upon what your definition of ‘exercise’ is. Because I could also say you don’t need to wait 6 weeks before you exercise.

The problem I come across is that many doctors aren’t specific about what they mean by exercise. So while they’re thinking a few walks and pelvic floor exercises would be good, I know a lot of women will be thinking ‘back to my old workout routine.”

What Happens If You Do Too Much Too Soon.

Even though you might feel ok at your 6 week check, it takes so much longer than we realise to recover from childbirth. Then there’s the pregnancy hormones, lack of sleep and breastfeeding to consider. I’ve written here about postnatal recovery already, and the potential consequences of too much exercise too soon, and this blog is a must-read example of what happened to one mum when she returned to exercise too quickly.

Your Pelvic Floor

The pelvic floor is the area that often pays the price if you overdo it, and unfortunately this is one of the things your doctor probably doesn’t tell you.

Pelvic Organ Prolapse is when 1 or more of your pelvic organs (bladder, rectum, uterus, intestines even) move out of place, and prolapse down into the wall of the vagina. I had 2 children, did my ante and post natal exercise qualification, and still hadn’t heard of this. (I’ve since studied both pregnancy and postnatal exercise to a higher level to rectify the gaps in the fitness industry’s basic training!)

And I really wish GPs, or even the hospital/ homebirth team, would give new mums some information on this AS STANDARD! Because prolapse can have such a huge impact on your life, I’m sure a little information would lead to a lot of mums making far more sensible decisions.

Diastasis Recti

This is something else that I really wish GPs would check, but generally they don’t. I can count on 1 hand the number of mums I’ve met (out of 100s) who have had their diastasis checked at their 6 week appointment. For more information about what exactly diastasis recti is, read this blog, but it’s another biggie in that if it isn’t healed, you’re at a higher risk of injury or pelvic floor problems if you do too much too soon.

doctor 2In fact, I don’t know about you, but my 6 week checks have been a quick blood pressure check and then asking what contraception I was using. In case the 6 week baby wasn’t enough!

In many cases the check up is more about the baby than the mum, and even though one of mine was a seperate appointment than the baby check, it still didn’t go anywhere near as deep as it should. The only way to know for sure what’s happening with your pelvic floor is too see a Women’s Health Physio (if you’re local to me I recommend some here).

So What Can I Do?

I said before that you don’t have to wait for 6 weeks until you exercise, and you don’t. But I’m talking about exercise so gentle you may not even think of it as exercise.

You’re advised to start your pelvic floor exercises (kegels) as soon as you’ve had baby, and you can start doing some gentle deep core connection work after a few days. Even with a c-section, you can do these from around 7-14 days. I do this with clients and mums doing Restore My Core, as there can be a loss of responsiveness in those muscles, which needs to be restored.

Following on from this, progressing to glute exercises to promote pelvis and hip stability is also beneficial. This, plus some gentle walking when you feel up to it (and I’d advise a few weeks rather than a few days for that) can help in a number of ways:

Faster Recovery Post Birth

The pelvic floor exercises will increase circulation to the area, helping to heal any tears, and both the core and floor work will help your nervous system to re-connect to these muscles.

Healing Diastasis and Preventing Incontinence

The right exercises, especially those that involve the deep transversus abdominis and pelvic floor, will help to heal diastasis recti. And pelvic floor exercises will help you regain control if you’re suffering from any leaking post-birth.

Reduced Pain

Having a stronger core will help take the pressure off your back muscles, which have to pick up the slack when the rest of the core isn’t functioning properly. Some gentle stretching and release work can help with this too.

The best course of action is to follow a specific post natal restorative programme, such as Restore My Core, but to learn more now you can download my 10 Tips for getting into shape after baby. And remember- the most important thing in the early postnatal period is rest, and when you do start exercising it should make you feel better, not worse. If you feel fatigued after you may have over done it. Listen to your body, and take it slowly.

Should postnatal mums do ab curls?

I’ve talked a lot on social media about crunches and sit-ups being a no-no when you’re postnatal, but a video I shared on my Facebook page recently seemed to really hit the mark. Aside from the comments and shares, I had quite a few mums tell me how clear it made things for them.

So I thought it was about time I wrote a blog on this. Unfortunately there’s a lot of bad advice out there when it comes to postnatal exercise, and many new mums do crunches to try and flatten their tummies, so we need to keep spreading the word that IT DOESN’T WORK!

Before I carry on, here’s the video:

 

Sit-ups, or any variation of this movement that works the six pack muscle, can cause more harm than good.

So, if you’ve recently had a baby and you’re doing sit-ups, STOP them immediately!

During pregnancy the first thing your six-pack muscle (Rectus Abdominis) does is lengthen, vertically. Then, as your pregnancy develops, and your baby grows and your bump gets bigger, this muscle starts to separate around your belly button.  This is referred to as Diastasis Recti. The abdominals can take time to re-align after your baby has been born, so for several weeks and indeed months (or for some, years) after birth, your six-pack muscle remains in a lengthened, separated state.

The first thing we need to do regarding this area is actually focus on connecting to your pelvic floor which is a bit like a sling of muscles supporting you from underneath, and the deep abdominal muscles which lie under your six-pack muscle.  This deep muscle is known as the Transversus Abdominis (TVA).

Strengthening the abdominals after birth, and specifically the TVA and pelvic floor, is a bit like building a house.

If your house has a solid framework and foundations, it will always be strong.  If you work on strengthening the deepest muscles first, then focus on the next layer, then the next layer after that, then your abdominals will re-align to their original structure.

What do crunches do?  They strengthen and work the six-pack muscle.  During pregnancy, we know that this muscle has lengthened and separated.  If you don’t have a solid foundation underneath this six-pack muscle before you work it (I’m talking about your core and pelvic floor here), then by doing crunches, you’re actually going to make your separation worse.  In other words, any separation you had after birth, will now be wider, because you’re forcing the muscle to strengthen, when it’s still in a weakened, separated state.  The amount of abdominal pressure placed on the six-pack muscle when performing a sit-up, forces it to separate further apart. As shown in my video.

And here’s what the pressure can do to your pelvic floor:

 

I follow a system with postnatal clients which involves locating the TVA first.  We connect to and strengthen that, along with lots of focus on the pelvic floor.  Once function in these muscle groups has been gained, then strength work can be done.

So, I hear you ask: “Why do people do sit-ups?”.  Well, in most cases, people do sit-ups in the hope that they will get themselves a toned, flat stomach and a noticeable six-pack.  I’m here to tell you that doing sit-ups AREN’T going to help you (as a postnatal woman), or anyone you know, male or female, get a six-pack.  Your body needs to be extremely lean to do this, which has nothing to do with sit-ups! (See this blog for my thoughts on having visible abs as a fitness goal.)

As a final point: I don’t even use sit-ups for clients who don’t have diastasis recti. As explained on athletic coach Eric Cressey’s website here:

“World-renowned low-back researcher Dr. Stuart McGill says that we have a finite number of flexion/extension cycles in our back until injury is caused. That number is different for every person, but the bottom line is that by performing exercises like crunches and sit-ups, you’re increasing your risk for injury with every rep!”

Plus, they’re promoting a rounded posture, which is the very one I’m usually trying to get clients out of, after too much time sat at a desk!

I do sometimes use crunches, but never in the early postnatal phase, and doing a crunch where you are engaging your transverse abdominis is very different to an uncontrolled crunch. So I recommend having a professional (physio, trainer) teach you how to do one properly, and also assess whether you need to do them.

Please share this blog and forward it to anyone you think might find it useful, as unfortunately I still see a lot of ab dominant work recommended for postnatal women- this myth needs busting!

For help with your postnatal fitness click here to find out more about my next Restore My Core course, or get my 10 Tips for getting back in shape here. You can also read what core exercises ARE safe and effective when you’re postnatal here.

I love babywearing. Unfortunately, I’m a bit crap at it. I gaze longingly at the amazing mamas with their beautiful wraps (especially Oscha Roses. I want the roses), but I never managed to get the hang of them. In a way this may have been a good thing: having seen the size of some of the stashes out there, I think it’s a slippery slope to wrap addiction…

I managed a stretchy wrap with my second when he was teeny, then moved on to a soft structured carrier (SSC) for back carries as soon as I could (4 months). I got to keep him close, while staying hands free to play with big brother (and do household chores and stuff. But I won’t pretend any of that got done very often).

babywearing and diastasis recti

Back carry with the Boba!

And after starting out in the dreaded Baby Bjorn (more about why the ‘dreaded’ part later), big brother progressed to a toddler SSC too.

Look at the sleepy dust in action!

Babywearing works its magic!

But what was happening to my diastasis recti while I was strapping baby to my back for hours every day?

There are 2 aspects I want to look at here: the core itself, and what the pressure of a strap around the tummy is doing to it; and posture, and how baby wearing can affect that.

The reason I’m so keen to do this is that, if done incorrectly, babywearing could hinder the recovery of your core and pelvic floor. However, I don’t believe this needs to be the case, and I have seen advice out there warning mothers to stay away from front carries until diastasis has healed, or questioning if it’s ok after c-section. And I don’t want anyone to be scared off. BECAUSE BABYWEARING IS AMAZING. Did I mention that?

The Core

I’m going to start with the core itself. And perhaps not the core as you think of it, because for many of us, core means ‘abs’. The ‘Core 4’ that I want to focus on are the diaphragm, the transversus abdominis (TVA), multifidis (low back muscles), and the pelvic floor. This video from physiotherapist Julie Wiebe explains it brilliantly:

So, as you can see, pressure from wrapping too tightly around the tummy is going to put a lot of strain on the diaphragm and the pelvic floor. Plus the first step in post natal recovery is training the breath, and this can interfere with that big time!

 This was my mistake.

 I wanted baby as high up on my back as I could get him. I was advised to have the strap up on my ribs, but I couldn’t get it to stay there, it would slip down. So I strapped it as high up on my tummy as I could, and it felt like if I didn’t have him strapped tight he would drop down and the strap at the front ride up. So I would pull the strap firm, pulling my tummy in with it. This is over utilising that TVA muscle, and tiring for my low back. After 3 hours of this (he went through stages of having MEGA naps back there!) it would feel pretty achy!

It also had the effect of giving me some rib flare (or at least exaggerating some that may have been there as a result of my pregnancy).

So should I babywear if I have diastasis recti?

I have seen the advice that front loading carriers should not be used until any diastasis is closed, to avoid pressure on the abdomen. This advice was accompanied by a picture of a front facing out Baby Bjorn. Just like this lovely holiday photo of me with baby number 1.

e56a76_2477ba12b2f7426987abf3657bebd7aa

Is a forward facing front carry bad for postnatal abdominal seperation?

BB carriers don’t get such a deep seat for baby as SSC or wraps (you can see my little one’s legs dangling in this picture, rather than being in a hip healthier ‘froggy’ position), and the facing out position is often not advised anyway. Plus, BB is the worst culprit for pulling the shoulders forward into hyper kyphosis (see below). So with regards to this particular carrier, I agree. But others?

Certainly, increased abdominal pressure could worsen diastasis.

And because babywering is usually done for a fairly long period of time (up to an hour+, compared to picking up a buggy or a short time carrying baby in your arms) then comparitavely it is likely to put more pressure on your pelvic floor.

Making sure you engage your core and floor while you babywear is important, and ideally seeing a Women’s Health Physio will make sure you’re doing this correctly, and assess how much babywearing your pelvic floor can cope with.

But you’re going to be carrying baby anyway, and a good fitting wrap or carrier will keep baby snug and closer to your centre of gravity, so easier to carry. And it should also be easier to correct your posture using a carrier, compared to having baby in your arms. In fact, a wrap can make baby feel even lighter, as it spreads the weight. So babywearing won’t necessarily delay healing, or increase abdominal pressure.

But you need to consider duration.

How long will you babywear for? You may need to start with short periods of babywearing and build up as you get stronger. Again, having your pelvic floor assessed for endurance by a WH Physio is the best way to know what’s suitable.

And you need to have the right posture.

You could be doing excellent work on rehabilitating your core, but if you stand in poor alignment all day you will be undoing all that work.

After having a baby you are left with a weakened core- the transverse abdominis, multifidis, pelvic floor and diaphragm work together to maintain stability as a unit, and your TVA and pelvic floor have just had a hard few months! So many women have postural problems after birth as it is. A poor wrap or fitting carrier will not help this.

If you’re not in alignment some muscles may not activate as effectively, while others overwork. Let’s look at what good posture should look like first.

posture postnatal abdominal seperation

How aignment affects diastasis recti

The cues you’re looking for are:

Ribs over hips with a slight arch in the lower back, tall upper spine, and chin tucked in (as opposed to head sticking out like a turtle).

Neutral pelvis. If you fully tilt your pelvic forwards (think glamour model back arch), then tuck your bum right under, neutral is roughly in the middle of these two extremes. The two most prominent points on your pelvis should be level with your pubic bone, forming a tripod.

For more detail here’s another video talking about rib position:

What does poor posture look like?

Imagine you’re standing with your fly undone. If your bum is tucked under (posterior pelvic tilt) or tilted forward (anterior pelvic tilt) the fly is more likely to gape. Same thing with diastasis, and your pelvic floor will not be in optimum alignment with your diaphragm. Regardless of whether you babywear, if you stand like this all day then DR is less likely to heal.

The problem is babywearing can exaggerate these postures.

Hyper-kyphosis is the ‘bell rung down’ position Julie Weibe talks about in the video above. It looks like slouching, and as well as hindering healing, it is a risk factor for pelvic organ prolapse (Altmen et al 2008).

Then there’s a sway back, which is quite common when carrying a baby- sticking out the tummy whilst leaning back to support baby up on your chest. The result- weakened core muscles, prevention of abdominal healing, and possibly low back and hip pain.

What about after C-Section?

I have seen the advice to avoid post c-section, but again, if you’ve recovered enough to lift your baby, I can’t see why you wouldn’t be able to wear him. My main concern would be pressure on the scar, and a stretchy or ring sling should sit much higher than that. I’ll discuss all the options below, along with guidelines to follow, but see here for one sling consultant’s experiences with various wraps post section.

Which carrier is best?

This is a bit like having to decide which flavour ice cream, is best, it depends who you ask! (Oh dear, I’ve got Craig David’s What’s Your Flavour in my head now.)

Stretchy Wrap

As the name suggests. It’s stretchy! Simply a length of material, but the stretch means you can pre wrap and slip baby in. Weight is distributed all over the shoulders and waist, and the stretch makes it really comfy.

Woven

A stretchy without the stretch, it takes a bit more getting used to these, but as baby gets heavier he will need more support, so this is the next step. There are multiple multiple ways to wrap with a woven, so there is loads of versatility to find a style comfortable for you, and that spreads the weight in an easy way to maintain good alignment.

Ring Sling

A sling that goes over one shoulder, you can do hip carries with an older baby, or a froggy position with a newborn. The downside is that the pressure is all on one shoulder (although it is spread over the shoulder) so keeping upright can become challenging after a bit. I struggled with more than 20 minutes with mine as it made my shoulder sore, but they were both large by this point and I was unused to the carry. The plus side is they’re quick to use, there’s no pressure on the waist itself, and newborns are light.

Soft Structured Carrier/ buckles

A panel, with a buckle at the waist and for the arm straps. Easy to use, and they come with different degrees of padding, so find the one you find comfiest and fits your shape best, so as to distribute weight as evenly as possible.

Mei Tai

Like a SSC but instead of buckles you tie the straps.

Are you wearing correctly?

Here are some tips-

  • Follow the TICKS guidelines. Having baby close enough to kiss in particular will help with posture.

  • Get help at your local sling library to make sure you’re wearing correctly, if you have one. Also try out a few different wraps to see what works best. There are online stores that rent slings, in the event there isn’t a library near you. For those local to me, Harrow Sling Library or the Chiltern Sling Library are the nearest

  • BUY ALL THE WRAPS! Well, maybe not all, but owning a selection of carriers means you can vary the pressure on your body, kind of the same way it’s good to wear a variety of shoes for your foot health.

  • Take a break. If you do find yourself struggling with posture, or with a large DR, if possible try not to wear for long periods at a time, to give your body a rest. Also, getting dad to wear when he’s there gives you a break. And who doesn’t love a babywearing daddy?

And remember, if you get good posture to start, you’ll get stronger and it will get easier to maintain with time.

Babywearing can feel like a lifesaver if you have a clingy baby, and I wouldn’t want any mum to feel that she couldn’t do it. Plus, I see plenty of mums pushing buggies in poor alignment too.

Get it right and it’s a wonderful way to carry your baby, bond with your baby, and help build your own strength.

If you’re unsure about your alignment and how’s it’s affecting your recovery, it’s a big component of my Restore My Core programme. Click here to learn more and grab a spot on the next course.

Maybe my first question should be have you heard of it? Because unfortunately many mums haven’t. But you know that poochy tummy some women are left with after having a baby? This can be the cause.

And those who have heard of diastasis tend to focus on closing the gap thinking then all will be well, but there’s a bit more to it than that, so read on to learn more…

What is Diastasis Rectus Abdominis?

The six-pack muscle (rectus abdominis) runs from your breast bone to your pubic bone and is joined together with a strong fibrous sheath called the linea alba.  In some pregnancies, the linea alba becomes a little darker in colour and is visible on your stomach. This is called linea negra which simply means “dark line”.

You may have heard people talk about your abdominal muscles “splitting”.  Your muscles don’t “split” because they’re already in a separated state and held together by the linea alba.  A split muscle is like a torn muscle, so if you’ve ever torn your hamstring, for example, you’ll know what this pain is like!  What happens to the abdominal muscles during pregnancy is completely painless, you aren’t aware of it, and I like to refer to it simply as abdominal “separation”.

The rectus abdominis stretches vertically (up and down your stomach) to accommodate your growing baby, and when it can’t stretch any further up and down it starts to separate horizontally (from left to right).

diastasis recti

I guess it’s a little bit like the linea alba is heavy duty cling film stretching apart. And when you’re growing a baby in there, it will stretch apart! When this happens, it’s called Diastasis Rectus Abdominis. It’s not clear how many women get this in pregnancy, as there isn’t a huge amount of reseach to go on. The latest research suggests that 100% of women develop it, but as Physical Therapist Julie Wiebe explains here, there are flaws in this study. Another one found that 66% of women had diastasis in the third trimester, and 53% continued to have it immedietely postpartum (read more here).

It should heal on its own by 8 weeks post partum, (Coldron et al 2008) but if it doesn’t don’t worry, this is far from uncommon! It just means you need to work out why it isn’t healing, and do a few restorative exercises to help.

If you don’t and your DRA remains, your body will be forced to rely on other muscles to stabilize the pelvis, which can lead to:

– Back pain

– Pelvic pain

– Incontinence

Pelvic organ prolapse

– A tummy pooch that never goes away

It’s not just about closing the gap

In fact you can have a diastasis and still be functional. I have about a finger’s gap there still! You also need to consider the tension of the midline: there is a big difference between having a firm and functional gap, and a gap that is soft with lots of give.

You need to consider WHY the gap is there. Yes, you grew a baby (again well done for that! I never fail to be amazed by how awesome it is that we can do that!)

But it should heal in the first few months after giving birth. If it doesn’t, this is down to too much pressure in the abdomen which then pushes out on your tummy or down on your pelvic floor. This happens when your core isn’t functioning as it should, so it isn’t managing to control the pressure.

What to avoid

Any exercise that puts repeated forward pressure on your abdomen could very well be making your diastasis worse.

This means avoiding many common exercises such as crunches, sit-ups, and conventional planks. I discuss this in more detail in this blog.

Diastasis can also be worsened by poor posture and an imbalance in the muscles of the core.

So what do you need to do?

It’s about connecting with your core to recruit the right muscles, and this starts with how you breath. Which sounds too simple but it’s SOOO important, and where I start with all my clients. You can read more about this here.

And you can’t look at your core in isolation. Your alignment, nutrition and stress all affect your diastasis recti. And you have to do the exercises RIGHT (we look at all of this in my Restore My Core programme).

It sounds odd, but one of the hardest things for me is getting clients to back off: the exercises are subtle, and no way as hard as what you are probably used to doing. I struggled to get my head round it. I spent years working in gyms taking abs classes and pushing through that burn. But contracting the deep transversus abdominis muscle is subtle, and until you have connected and it is happening naturally you risk just engaging the abs and obliques and having them take over. Then they pull on the midline and stop your diastasis from healing. This blog has some diastasis safe exercises to get you started.

For more advice download my 10 Tips for getting back in shape after having a baby.

There’s no shortage of advice on what exercises you should be doing to get your ‘pre-baby body’ back. Problem is, not all of it’s good advice.

postnatal exercise advice

First off, I hate the ‘get your pre-baby body back’ thing. It is not a race to see who can shift their pregnancy weight fastest, and it encourages mums to throw themselves into exercise and dieting to do so. Not healthy.

And whilst it’s fine (not vain) to want to change how you look, you shouldn’t have to feel ashamed of your post-baby body. You need to take it slowly and be gentle on yourself, take time out and be a little selfish (except it’s not really selfish- happy mum means happy baby).

But back to the advice itself.

The Good.

Let’s start with some exercises you CAN do. I’m going to link to someone else’s website here, so you don’t have to just take my word for it!

Marianne Ryan is a top Womem’s Health Physio, and I’ve shared this blog of hers with clients before, to reiterate what we’ve talked about in the session. It includes safe, effective exercises, that I use with personal training clients and in Restore My Core.

Good advice is about how to connect to your deep core. Training the breath and pelvic floor. Click here for Marianne’s advice on how to get a flat tummy.

The Bad.

Here’s a blog with ‘4 Moves to Target Your Mummy Tummy.’

However it’s more like 4 exercises to make your mummy tummy worse!

While this article does say to check with your GP if you have diastasis recti, it’s misleading in saying these exercises are how you should get a flat tummy post partum.

I’m not saying never do planks or crunches (although crunches would never be my exercise of choice to get a flat belly, postnatal or not), but you have to go through a progressive restorative programme first.

Any exercise that creates a lot of abdominal pressure, like these, runs a big risk of pushing your tummy out, not giving you a flat stable core. For example, the strain of the double leg lifts could lead to the low back arching, or pushing it into the ground to compensate, both of which put the pelvis in a non-optimal position for the transverse abdoninis and pelvic floor muscles. And the rectus abdominis and obliques can end up taking over, placing strain on a weakened linea alba.

Bad advice involves ab exercises, feeling the burn and anything that leaves you straining while you train.

The Ugly.

This one is actually part ugly, part good. But then I wouldn’t have had a nifty blog title, so I just went with ugly.

The first link mentioned girdles, and I want to talk about that some more. Are they a good idea postpartum?

Waist training has been in the news a lot recently, in large part thanks to the Kardashians making social media posts like this:

e56a76_264525e951d74115aff4113cb2fe862f

And because this was after giving birth (although over a year later), women can see it as a good way to get their tummy down. But wearing a supportive garment after having a baby is completely different to waist training, so please don’t confuse the two.

To start with I wouldn’t recommend this type of waist training. If you squeeze your tummy in like that, where do you think all your organs are going? Where is the pressure going?

Up or down is where. And pressure down on your pelvic floor is not a good idea, ever. Especially not when postnatal. It is going to put you at huge risk of pelvic organ prolapse.

And pressure up on the diaphragm? Hiatus hernia anyone?

On top of  which you will actually be preventing your core from functioning properly. Here’s a video from Women’s Health Physio Julie Weibe that explains this beautifully.

But a supportive belt postpartum is different. They provide support spread around the torso, rather than just squeezing one area. This can give extra support to weakened abdominal muscles, reduce postnatal swelling, and encourage them to close back together whilst regaining tension.

Because it isn’t just the gap between the muscles that’s the issue. It’s the ability to create tension along the linea alba, which is the tissue in that gap. And if you close the gap without restoring function, your core still won’t be able to do it’s job properly, and any symptoms you may be having, like pelvic girdle pain, low back pain, or incontinence, will likely remain. You need to relearn how to use the deep core muscles and address your alignment.

If you do have abdominal separation and are considering a belt, I really recommend you see a Women’s Health Physio first. They can make sure the belt is fitted correctly and address any underlying issues with a tailored programme.

You can be referred by your GP, or you can find one to see privately here, just make sure you pick Women’s Health from the drop down menu.

Anyone local to me, I recommend www.beckyastonphysiotherapy.co.uk, having seen her myself.

I hope this article helps give you a bit more confidence in being able to distinguish between the fitness advice that’s worth following, and that which is best ignored. And as a mum, I trust you’re pretty good at listening to bad advice, nodding along, then going along on your way whilst ignoring it completely!

The final video in my core series for Mums of Steel. Here I talk about alignment and how it can affect the healing of your diastasis recti.

If you haven’t already seen them, here is part 1 and part 2.

For an assessment and programme to help establish optimal alignment for diastasis repair, contact me for your free personal training consultation.

The second in my video series for Mums of Steel, looking at how our breathing technique affects the core. An important part of core training that is often overlooked!

If you haven’t watched Part 1, click here to watch it first.

To make sure your post natal training is on the right track book onto a class here.

To watch the final part in this series, go to Part 3 here, about how your alignment can affect your post natal recovery.