Enormous changes have occurred in your body during pregnancy; not only physiological, but also mental and emotional changes. Your body has done an incredible thing, so after giving birth please be merciful on yourself, on your body and allow yourself time to recover from the changes caused by pregnancy and childbirth.
Once your baby is born, your core area begins to go through a major transformation, once again. The internal organs re-establish their position and the abdominal muscle begin to heal slowly. The recovery of your abdominal wall is quite slow, and the process will be ongoing for at least a year after birth.
Your uterus is fast to react to the change in circumstances; it begins to shrink and halves in size in a week. The change is quite evident, as in the first weeks postpartum the uterus can be easily felt and it makes the abdomen round, but within about three weeks, your uterus is so small it can no longer be felt. By six weeks, the uterus has returned to its pre-pregnancy size.
Activation of deep abdominal muscles after pregnancy
Abdominal muscle wasting occurs in every pregnancy during the last trimester; it is an inherent way for the body to make space for the growing uterus. They have gone through the mill, but you should go ahead and start working on your abdominal muscles soon after giving birth, beginning with more gentle deep muscle exercises, and gradually, within 4 to 6 weeks, working your way to superficial muscle exercises. Pay attention to the timely activation order of your abs, so that the tendon seam is not subjected to too much pressure and it remains sinewy, which helps in maintaining control of the entire core. Whether training or going about your everyday life, pay attention to your core and maintain good posture, for example when lifting, carrying, and breastfeeding the baby. This helps to promote the recovery of core muscles and prevents back pain.
What is abdominal muscle separation?
Abdominal muscle separation (diastasis recti) is very common during pregnancy and refers to the widening and narrowing of the tendon seam between the straight abdominal muscles. This tendon seam extends all the way from the sternum to the pubic symphysis and unites the right side of the body to the left. Typically, a 1 – 2 centimetre tendon seam widens to about 4 to 8 centimetres during pregnancy.
Most women recover from abdominal muscle separation in the first 2 months postpartum with no intervention required. However, more than 30% of new mums experience challenges with abdominal wall function, often associated with disorders of both, deep muscle, and tendon seam activation. This happens when the tendon seam connecting the abdominal muscles does not reach sufficient tension but remains loose. You should talk to your healthcare professional or a physiotherapist who specializes in maternity care, if the midline of your abdomen feels spongy-soft, 2 to 3 months postpartum, or if you can see the midline protruding clearly upwards when you are lying on your back and lifting your head towards your belly. Stomach bloating may also be associated with abdominal separation, or the separation can appear gap-like, in the middle of the muscle. Diastasis recti, or abdominal separation, can cause problems with the control of good posture and deep muscles; it may also cause lower back pain and disorders of intestinal function.
Before the rehabilitation begins, your healthcare professional will determine the reason why the tendon seam does not seem to activate, before establishing a program of rehabilitative exercises. The goal of the rehabilitation is for the tendon seam to become sinewy and the overall functionality of the middle body to improve.
What causes the belly to bulge after pregnancy?
Your body was gaining in weight for over 9 months and your abdominal muscles have stretched considerably. Realistically, it will take some time for you to shed that extra weight and for your body to return to its pre-pregnant shape; your body position and posture has also changed.
Bulging of the belly postpartum, can sometimes be linked to abdominal muscle separation, but is more often due to poor posture. After delivery, your posture may not return to normal, yet the abdomen continues to protrude. Due to the position, the superficial muscles of the back are tightened, and the deep muscles are not properly activated.
During pregnancy and after childbirth, the deep muscles in your core are not able to function quite optimally because they have been subjected to so much stretching. If there are problems with the spontaneous recovery of the abdominal muscles, the deep muscles may remain inactive, preventing them from regulating the pressure in the abdominal cavity and making the abdomen look puffy. Sometimes the superficial muscles of the upper abdomen are overactive, creating pressure on the lower abdomen, which is also reflected in the bloating of the abdomen.
Due to genetic factors, the extent that the skin of the abdomen stretches and recovers, varies from one woman to another, so you really shouldn’t rush to compare yourself to others.
Pelvic floor recovery
Overall recovery after childbirth takes at least a full year. Several factors limit your body’s ability to fully recover; for example, breastfeeding has a softening effect on the body, and relaxin continues to work in the body up to a year following childbirth. Relaxin is the hormone, which during pregnancy loosens and relaxes ligaments, joints and soft tissue, thus preparing the body for childbirth.
During pregnancy, relaxin has a softening effect on the pelvic floor, due to it being 70% connective tissue. The pelvic floor muscles and vagina also stretch considerably during childbirth, and the pelvic floor may experience tearing. However, the vagina has good blood circulation and any damage usually heals quickly without leaving scars. Vaginal recovery from childbirth takes a few weeks, and pelvic floor function usually returns to normal within the first three months. Strengthening of the pelvic floor muscles during pregnancy and postpartum, has been found to be an effective means of preventing pelvic floor function problems.
Having said that, sometimes the problem can also be overexertion or tightness of the vaginal scars, in which case strengthening exercises can only be more detrimental. For this reason, a professional assessment of the situation is always recommended.
Rehabilitation advice for a new mum
Every new mum needs caring for; her body has undergone tremendous changes that can make it feel foreign or even broken. Mums deserve expert and reliable guidance and advice that are easily applicable to their daily lives. Seeking immediate postpartum counseling plays a significant role in postpartum recovery, as small actions play a big role.
To support spontaneous physical recovery, exercises are often needed, for example, to rehabilitate the pelvic floor and abdominal muscles. Consider consulting a physiotherapist or other postpartum expert to better understand your changed body and how to rehabilitate it in the best way.
Various aids can also be used to support recovery, such as a postpartum support band, which allows you to keep better posture and activate your core. A band provides support for stretched abdominal tissue and a possible c-section wound, potentially promoting the recovery of abdominal muscles. The right support band makes it easier for you to control your core in all daily activities, such as carrying and lifting the baby, while making movements more comfortable and secure. The use of a support band can be started safely immediately after delivery, as long as it does not cause a feeling of pressure in the lower abdomen or pelvic floor.
Your body will take its time to heal. Step by step, you can start increasing the intensity of exercises, as physical training holds the key to a full recovery. If you have any concerns at all about your recovery, don´t hesitate to turn to a professional.
*By Pregnancy and Pelvic Health Physiotherapist Mirka Katajisto
Mirka is a Maternity Physiotherapist specialising in pelvic floor health during and after pregnancy. She helps women with postnatal rehabilitation of abdominal and pelvic floor muscles, and offers helps with various pain symptoms. Her background in fitness and Pilates allow her an important insight to postnatal recovery. She's also a mum of three children.