Many women find that their body changes quite significantly after pregnancy, and often, those changes are most noticeable in the abdominal area. Your abdomen might look and feel different, and even if you return to your pre-pregnancy weight, you might still notice changes in your stomach. And although appearance might be part of the changes that can occur, the more important change is in function. If your post-pregnancy stomach is causing you to have pain in your abdomen or back or is otherwise affecting your daily life, there may be a deeper issue at hand.
What Happens to Your Stomach During Pregnancy?
Brooke Cates CEO/Founder of The Bloom Method, a pre and postnatal fitness program available both online and in Denver, Colorado, explains that during pregnancy, the muscles of the abdomen separate naturally to create space for baby to grow. Thanks to the hormones of pregnancy in a woman’s body, especially relaxin, the abdominal muscles are able to separate. Because every woman is different and will respond differently to relaxin in the body, some women may notice more abdominal separation earlier than others. (This is also why mothers who have already experienced a pregnancy might “show” sooner as well, as their body adapts to the relaxin sooner.) And no matter what kind of shape a woman is in before her pregnancy, Cates, who is a Certified Personal Trainer, Pre & Postnatal Corrective Exercise Specialist, Diastasis Recti + Core Rehabilitation Specialist and Pre & Postnatal Holistic Health Coach, stresses that it’s important that all women realize that the rectus abdominis (the six-pack muscles) will naturally separate in almost all expecting women. And this separation puts a gentle strain on the linea alba, which is the connective tissue connecting the abdominal muscles. That strain, Cates continues, means that even small, daily movements, like getting out of bed or picking things up create irregulation of the intra-abdominal pressure within the abdomen, potentially weakening the connective tissue and muscles of the pelvic floor. Essentially, there’s a disconnect between the muscles needed to maintain the core and over time, that can lead to damage. And although improper abdominal exercises can be harmful to a woman’s core, Cates explains that the bigger issue is those daily actions, repeated over and over, that actually damage the core.
How to Tell If Your Core Is At Risk
If you’re currently pregnant, you might be wondering how exactly you’re supposed to know what’s going on with your core, especially at the deeper levels of the muscles. One easy way to tell is to look for “doming” in the middle of your stomach with activity. If your muscles are separated and the connective tissue holding your abdominal muscles are weakened, using your ab muscles improperly leads to pressure that pushes up on the tissue and down on the pelvic floor, which weakens both areas. That upward current of pressure is also what leads to the “doming” in the middle of a woman’s stomach, so it’s a sign that her core is not being activated properly. The “doming” can occur after pregnancy as well, thanks to muscles that have remained separated, so you want to avoid doing any exercise or activity that leads to doming. “The more a woman allows the doming to occur during [and post pregnancy] the more damage she does to the linea alba [connective tissue] thus cause the tissue to lose its integrity and create more difficulty in healing post-birth,” Cates explains. “There are tons of movements we do every day, even more if we’re pregnant with our second or third baby, that cause an increase in the abdominal pressure,” she says. “When women aren’t taught how to regulate this pressure through correct breathing patterns and functional inner unit firing upon performing the movement, these daily actions can cause serious harm to the core, pelvic floor, and connective tissue, leaving women with an injury called diastasis recti or even pelvic floor injuries like prolapse an incontinence.” You know how mothers “joke” about peeing their pants after having babies? It’s actually nothing to joke about; urinary incontinence is the result of damage to the pelvic floor that can happen during pregnancy. It’s not only important that we re-assess the way that we exercise during pregnancy, but the way our core relates to every movement we do during our day. Taking charge of this can truly change the course of the core’s reaction to the changes it undergoes during pregnancy. But don’t worry—there is good news: “When protected, through correct core activation upon certain movements that create an increase in abdominal pressure, the connective tissue can heal naturally post-birth, drawing the sides of the rectus back towards one another,” Cates says.
How to Heal Your Core After Pregnancy
As Cates explains, there isn’t just one thing you can magically do to heal your core after pregnancy. Instead, for many women, the key is about “relearning” how to do many everyday movements with the proper core activation. In her exercise classes, Cates teaches moms special techniques designed to properly maintain their core, such as diaphragmatic breathing, the Bloom Method “belly pump,” and deep core activation. More importantly, however, Cates stresses that for true core strength, all women have to address the way they use their core in daily movements, such as getting out of bed or picking up their baby’s car seat. One of the most important things a woman can do, Cates stresses, is to learn how to breathe properly. It might sound silly and women who are used to going hardcore in their workouts might first balk at the idea of “just” breathing, but Cates maintains that it’s the single most important thing a woman can do before, during, and after her pregnancy for proper core activation.
What Not to Do
The most important thing a woman can do after pregnancy? Avoid all of those “traditional” ab exercises that we all know and love, such as crunches and planks. It’s more important, says Cates, to go slowly and ensure that all movements that involve the core are performed properly and slowly. “Oftentimes, if a woman jumps back into those challenging traditional core-based exercises that we all love, she will create some form of core dysfunction, making it harder on herself and her body to heal and re-strengthen appropriately,” she explains. Instead of jumping right back into holding a plank for minutes on ends, Cates might recommend that a postpartum woman first modify by doing deep core holds on all fours, then slowly progressing through modifications until she reaches a regular plank. “We often tell clients that it’s not always about the exercise but about how we perform the exercise and healing the core from carrying a baby for 8+ months requires some deep retraining to optimize strength and performance,” she adds.
Should You See a Specialist?
In other countries, pelvic floor therapy is a normal and expected part of medical care for all pregnant women. In the United States, however, not all women even know that pelvic floor therapy is an actual option that can help them. Studies have shown that pelvic floor therapy can be effective in both preventing and treating postpartum urinary incontinence in women. Cates especially recommends that all pregnant and postpartum women have at least one appointment with a pelvic floor physical therapist both during and post-pregnancy to get a diagnosis of what is going on with the muscles of the pelvic floor. “This can provide the individual with so much potent information while allowing them to understand where their focus should be when it comes to creating optimal balance in the pelvic floor,” she explains. In addition to pelvic floor therapy, Cates also often recommends chiropractic and soft tissue/myofascial work to her clients. And anytime you are struggling with issues such as back pain, stomach pain, or having urinary or fecal incontinence, or pain in the pelvic area, you should see a doctor who can help get you the right help you need. Pregnancy and the pelvic floor can affect a lot of different areas for women, so it’s important to realize how just vastly they are all connected. Finally, if you have been diagnosed with diastasis recti, it can be incredibly helpful to see a doctor or specialist who can help you through physical therapy to bring your muscles back together. As Astrid Swan, a celebrity personal trainer, notes, doing ab exercises with diastasis can actually further injure the abdominal muscles. You really need to bring the abdominal muscles back together in the proper way before attempting to do any exercises in the core area; think of it as trying to piece two broken pieces back together before they can work effectively.
Tips for Managing Your Post-Pregnancy Belly
You may have seen those “trendy” waist trainers that celebrities tout on Instagram as the secret to bouncing back after pregnancy, but Cates warns that women need to be careful about choosing a product for their core. Waist trainers probably won’t be an effective choice for supporting your core, but a postpartum splint or support might be a good choice for you if your doctor recommends it. The key, says Cates, is using a postpartum core splint as a way to support core health, not “fix” it. “When used correctly, they can be a great form of support and help create great amounts of core awareness,” she explains. “Wearing a PP splint can create an awareness in when the individual is using her core correctly and regulating the pressure increase that occurs and forgetting to fire the core and allowing it to protrude forward, which is what continues to weaken the inner unit.” If you choose a postpartum splint or support system, Cates and her team at The Bloom Method recommend:
Not wearing them for more than 6 hours a day Only wearing them during movement, such as cleaning the house, grocery shopping, walking, hiking, or exercising Never sleeping in them or nursing in them
Swan also recommends taking your time when easing back into workouts postpartum and being smart about how you choose to work your abs. She encourages women to:
Start slowly and be sure to be cleared by a doctor.Make sure that there is no bleeding, no pain in the abdominals, hips, etc.Start with breathwork. “It seems so simple but during our pregnancy, even our lungs are affected and you want to be sure that you can breathe and engage your core and Kegels without moving your spine,” she explains.Avoid crunches/spine flexion for a long time. Instead, lay flat on the floor and breathe, then slowly pick up one leg at a time, keeping one hand on the stomach to make sure you stay engaged. From there progress to lifting both legs up and tapping down, all through slow and controlled movements.
A Word From Verywell
Pregnancy can affect your core, but it doesn’t have to ruin it. “Fixing” a post-pregnancy belly goes more than skin-deep and is about learning how to properly activate muscles that may have been separated during pregnancy. And as more women become aware of just how their bodies work during and after pregnancy, more women can learn what is “normal” after birth. It’s not “normal” for a woman’s body to be in pain, ruined, or suffer symptoms such as incontinence after pregnancy and there are resources, such as pelvic floor therapy, that can help.
