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mommy tummy
Image courtesy of delmarbirthcenter.com

Mommy tummy aka diastasis recti abdominis (DRA) is a prevalent issue.

One in three American moms have DRA that persists greater than a year.

So what is a diastasis recti? It is the stretching of the linea alba, a connective tissue that runs down the midline of the abdomen and connects the abdominal muscles. The stretching happens during pregnancy in almost 100% of mothers to make room for a growing baby. Many of these moms are told this is a normal part of pregnancy, even by their healthcare providers.

DRA is not just about appearance, it is also connected to pelvic floor dysfunctions as well as pelvic and low back pain. In a study by Kari Bo et al., they found that mothers in the US with DRA were also more likely to have the following:

  • myofascial pelvic pain 33%
  • urinary incontinence 48%
  • fecal incontinence 7%
  • uterus prolapse 52%
  • bladder prolapse 57%
  • rectal prolapse 43%

With DRA being so prevalent and having many co-existing conditions, why do we still normalize this? Currently, postpartum therapy is not standard practice in the US like it is in Germany and France, who lead in postpartum rehabilitation. This remains the case despite the American College of Obstetricians and Gynecologists (ACOG) updating their postpartum care guidelines. The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:

To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.

Anticipatory guidance should begin during pregnancy with development of a postpartum care plan that addresses the transition to parenthood and well-woman care.

Prenatal discussions should include the woman’s reproductive life plans, including desire for and timing of any future pregnancies. A woman’s future pregnancy intentions provide a context for shared decision-making regarding contraceptive options.

All women should ideally have contact with a maternal care provider within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.

The timing of the comprehensive postpartum visit should be individualized and woman centered.

The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being.

Women with pregnancies complicated by preterm birth, gestational diabetes, or hypertensive disorders of pregnancy should be counseled that these disorders are associated with a higher lifetime risk of maternal cardiometabolic disease.

Women with chronic medical conditions, such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, mood disorders, and substance use disorders, should be counseled regarding the importance of timely follow-up with their obstetrician–gynecologists or primary care providers for ongoing coordination of care.

For a woman who has experienced a miscarriage, stillbirth, or neonatal death, it is essential to ensure follow-up with an obstetrician–gynecologist or other obstetric care provider.

Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit.

A more detailed list of ACOG’s guidelines can be found here https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care

Another limiting factor is that most medical insurance companies do not cover DRA or postpartum rehabilitation. However, the information regarding DRA is on the rise. Published studies have more than doubled in the last ten years (Aswini et al.,2019). Even with all this new data, there are still many myths and misnomers as to what is “normal vs common” postpartum. As more women continue to advocate for themselves and conversation on this matter continues to grow, we will hopefully begin to see these numbers decline.

Therapists who specialize in treating pelvic floor conditions are also trained to assess and rehabilitate DRA. Make an appointment with a trained therapist in your area, or contact us for in-office or telehealth sessions in California (or virtual consultations worldwide). This is not something you have to live with.

References:

Kn, S. S. (2019). An Overview of the Studies on Diastasis Recti Abdominis in Postpartum Women. Journal of Gynecology and Women's Health, 14(5). doi:10.19080/jgwh.2019.14.555900
Kristian, B. (2020, October 22). A painful postpartum injury is plaguing America's moms - but nobody really talks about it. Retrieved November 16, 2020, from https://theweek.com/articles/939114/painful-postpartum-injury-plaguing-americas-moms--but-nobody-really-talks-about

Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: Prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092-1096. doi:10.1136/bjsports-2016-096065

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Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by A.M.

Months after giving birth, it was difficult for me to go from a sitting or lying position up to a full standing position without feeling that I had to remain hunched over until a bit of time had passed to get fully upright. However, after taking Heather’s course, I learned exercises to get my body back to normal. She also showed me correct ways to lift and carry my son as well as put him in/take him out of the carseat and stroller. This class was really beneficial and Heather is a wonderful teacher who made me feel very comfortable.

-- A.M.

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

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Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

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Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

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Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

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