As a passionate Marathon runner I was really happy when I got a spot for Chicago Marathon, as it is one of the 6 World Marathon Majors. But then I found out that I was pregnant, and that Chicago Marathon was only 4 months after the due date. I was not sure if I should or could return to running postpartum and run a race so soon after giving birth. But giving up before even trying is not an option for me. So I secretly made a plan on how I could make returning to running postpartum work. And luckily everything worked out, and I finished the Chicago Marathon 4 months postpartum.
Diastasis recti abdominis (or DRA) is a condition where the tissue between the straight abdominal muscles separates. Diastatis literally means seperation in Latin and recti abdominis are your abdominal muscles. It is therefore sometimes also referred to as abdominal separation. This condition is most common in pregnant and postnatal women, because the growing uterus stretches the abdominal muscles. However it can also affect every man or woman for various reasons.
I was very careful to not develop diastasis recti during my pregnancy, and yet I am still facing a small gap between my abdominal muscles three months after giving birth. Therefore I am writing this blog post to explain the causes of DRA, how I tried to prevent it and how I am trying to treat it.
Note: I am not a doctor or health professional. Everything in this article is about my personal experience only.
How to diagnose diastasis recti
You can easily test yourself if you have DRA (unless you are currently having a baby belly). Just lie flat on your back and find your navel with your fingers. Press your fingers into your belly slightly below and above your belly button. Now lift your head. Your abdominal muscles should contract and you should be able to feel (or not feel) a small gap with your fingers.
In this Youtube video you can see an example how you can check for DRA.
Causes of diastasis recti
Pregnancy hormones and a growing belly
Diastasis recti abdominis occurs in more than half of all pregnancies. The reason is that you growing baby and uterus expand and put pressure on your abdominal muscles from the inside. The muscles and ligaments are already soft because of a pregnancy hormone called Relaxin. It is absolutely normal and okay for your abs to separate a little bit during pregnancy. However it is important to not aggravate the situation and to rehab it after giving birth. (see below). This is even more important when having several kids, as every pregnancy increases the likelihood of DRA.
Accidents with strained abdominal muscles
The tissue between your straight abdominal muscles can also stretch when you put too much load on it. This sometimes occurs with bodybuilders or power lifters, but also with everyone lifting heavy objects without the right technique (like lifting your kids or heavy furniture)
DRA in newborns
Diastasis recti is also quite common in newborn or premature babies, simply because their abdominal wall is not fully developed. This is not dangerous and most of the time it should go away on its own.
Prevention of diastasis recti
The biggest factor of preventing diastasis recti is to exercise your straight abdominal muscles the right way at the right time.
Always use proper technique
As DRA can also happen by accident, it is important to always use proper technique when lifting heavy objects. Always engage your whole core, and pick an adequate weight. Sometimes also belts and bands can help to stabilize your core, but they should not be used to lift weights that are too heavy otherwise.
Also when you are pregnant and already having a baby belly it is important to not engage your straight abdominal muscles. Therefore always use the right technique when getting in and out of a lying position. Never do it straight as you were used to, because this puts too much pressure on your straight abs. Always get up and down via your side. This means that when getting up, roll onto your side first and then push yourself up. When lying down lye down on your side first.
Train your straight abs before pregnancy, but stop after the first trimester
A strong core is beneficial for a lot of things, like better posture and less back pain. Therefore it is recommended to train your abs before pregnancy, but to stop after the first trimester or as soon as your belly starts to show. This also includes stability exercises like planks or other exercises that require engaged abs. You will see that when doing these exercises your belly will form a bulge outwards which is a general warning sign for DRA. Once your diastasis recti has disappeared you can train your straight abs again.
Train your obliques and transversus abdominus muscles during pregnancy and afterwards
While training your straight abdominals is not recommended later in your pregnancy as it can increase diastasis recti, you can and should train your side abs (also called the obliques) and your transversus abdominus. This is the muscle that spans your tummy horizontally and which is not very well known. But we use it everyday for example when coughing. The best exercises to train it however are breathing exercises that are also useful to recover from DRA after giving birth.
A study of the Columbia University also has shown that doing the right abdominal exercises during pregnancy can reduce the risk of diastasis recti compared to no exercises.
Treatment of diastasis recti
To treat diastasis recti abdominis you should first see a health professional, most likely a physiotherapist. Very often this is done in the hospital after birth or during a postnatal rehab course. In some countries this service is often covered by public or private health insurance.
I was assessed by a physio three days after giving birth, as well by my midwife in the weeks after. In addition I have completed a postnatal rehab class. In total I was given the following exercises to help with my diastasis recti:
- Belly breathing: when lying on our back practice active belly breathing. This means that you lift your belly when inhaling, and pull it towards your spine when exhaling. You can also imagine that the sides of you belly will move closer together, and that your belly button will contract towards your pubic bone.
- Belly breathing advanced: like with the exercise above, start with simple belly breathing. Now do a few sharp exhales while making the sound of the letter “F”. You can also try the letters “P”, “K” or “T”, and contract you pelvic floor upwards and inwards at the same time.
- Leg extensions: Lie on your back with your legs bent. Now slowly slide one leg to a straight position parallel to the floor, and pull it back.
I hope that with all that extra knowledge you will now be able to prevent and treat your diastasis recti. As always please contact a health professional if you have any questions.
If you are expecting your first child you are probably equally nervous and excited about it. And you wonder about a thousand things at the same time. Congratulations, this is absolutely normal. You will do great. And do make things even easier for you, here is a short list of things for your hospital bag that I really needed as a new mom, and that nobody told me about before. All of these are super helpful either for nursing, at the hospital or to recover from birth.
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“Giving birth is like a Marathon” is something you would hear frequently from non-marathon running people. Yes, both are tough, exhausting workouts, with a great reward at the end and a long, painful recovery. So when I ran 12 Marathons for charity in 2018 and got pregnant after Marathon no. 9, I thought I was overly prepared for childbirth and labor. I thought I would easily go through that painful process and have a speedy recovery because of my fitness and mental toughness. And I can say that this was at least partially true.
How Marathon running has helped me prepare for childbirth and labor
Everybody knows that you need to be fit and physically prepared to run a Marathon. Giving birth is not that different. It is a physical workout. Luckily your body will automatically train for birth. Your uterus will go through some “practice” contractions, also called Braxton Hicks contractions, before actual labor starts. This will prepare your uterus, which is in the end just a muscle, for real contractions.
In addition to my natural uterus contractions I tried to maintain my fitness throughout my pregnancy with moderate running, indoor cycling, and strength training. This helped avoiding back pain and excessive weight gain. And my arms and upper body were much stronger to carry my baby afterwards (which you have to do constantly as a mom). Here you can read my blog post on benefits and risks of exercising during pregnancy.
If you have ever run a Marathon you know that nutrition can heavily influence your race. It is recommended to eat a light and easily digestible breakfast low in fiber, and to take in easily digestible carbohydrates throughout your race. In addition you should stay hydrated. So I basically followed the same strategy when giving birth. I still had a light dinner when I was admitted to the hospital (while I had light contractions), and later during labor I fueled my body with a special sports drink that contained easily digestible sugars and electrolytes. I only changed my fueling strategy later when I had to get an IV.
After the race you should try to refuel properly with carbohydrates and protein. And this is also what you should do after giving birth. In my case I chose the healthy, fiber rich options from my hospital menu. The additional fiber was especially helpful to ease up my stool to avoid pain after my episiotomy.
Every Marathon runner knows: training and nutrition are important, but so is having the right gear on race day. And birth is similar in a lot of ways. You want to be equipped with the right tools to give you the birth you want. This could be a birth stool, a big gymnastics ball, a CD player or bluetooth speaker, a chair, a bath tub, massage oil or even just a baby toy to squeeze during contractions. You want to wear something that you feel comfortable in, but that can also get dirty. And just like in a Marathon: Don’t forget that hairband! Because you don’t want your sweaty hair all over your face.
If you remember your first Marathon you also remember the recovery afterwards. It is really hard. You were probably not able to walk for days, and you felt exhausted for a few weeks. Maybe you were in pain, and you could not properly sleep because of all the adrenaline. Giving birth is similar, no matter if naturally or via cesarean. Recovery will take a while, so don’t rush it. Stay in bed for as long as you want and need. Try to get good sleep and eat nutritious and healthy foods. Be proud of what you have accomplished. Soak up that feeling as much as possible. Soon you will be back feeling stronger than before.
Having a good support crew is important for your Marathon. You want people to take your anxiety away before the race, cheer you on during the race when you are feeling low and celebrate with you afterwards. Also for birth you need a support crew. This could of course be your doctor, your midwife, your doula etc. Bust most importantly it is your (birth) partner. You want to work together as a team in this very important workout. Ideally your birth partner should support you with whatever you need and lift your spirits when you are feeling low. Because running and giving birth is really a team challenge.
Nowadays mental training is considered a cornerstone of how professional Marathon runners and other athletes prepare for competitions. Maybe you have seen a professional skier on TV who imagines skiing the race and also moves the body accordingly. And it has been proven that their various strategies of how to visualize themselves in a competition before the event can increase the physical performance. And even though I am not a professional runner, I believe that the right mindset and mental training can improve not only your results but also your experience on race day.
And this is also true when it comes to labor and giving birth. There are a lot of visualization techniques that you can practice before your actual due date. Some techniques are quite simple like imagining a blooming flower or waves in the ocean. Others are marketed with fancy names like Hypnobirthing. I personally read a few books and picked the things that I liked. And I think that it has helped me at least a little bit during my extensive labor.
How Marathon running could not prepare me for birth
I will not lie about it: giving birth is way more painful than running a Marathon. There is no way to describe the feelings if you have never experienced it before. It probably is the MOST PAINFUL WORKOUT you will ever do in your life. But even if it is really painful, there is nothing to worry about. As a woman you will develop female superpowers and will find strengths that you never knew you had. Trust me, you’ve got this.
A Marathon has a fixed distance of 42.195 km. You probably know your pace, and know you can finish it in around x hours. With giving birth it is not the case. If you are giving birth naturally you don’t know when it will start, when it will end and how long it will take. It could be two hours or two days.
For me this was a bit worrying. My baby was already overdue and I was scared to have an induction. Even when it came naturally I did not know how long it would still be until I would be finally be done with all the pain (see point above). I did not know if I still had enough gas left in my tank, especially because I had never done it before. In the end, my labor lasted nearly 24 hours. Even if I have done longer races than a full Marathon and even one 24 hour race, I was completely unprepared for this.
When you finish a Marathon you are happy. Happy that you are done, happy that you have accomplished your goal, happy about the medal you get. But all the joys of Marathon running are so small compared to the feeling you have when holding your baby for the first time. When you hear your baby scream for the first time. And when you smell that precious baby scent for the first time. That feeling of joy is beyond everything you can ever imagine. And it is definitely worth all the long hours of pain and complications you might have gone through to get there.