Everything you need to know about your abs after birth

For all of the shiny, speedy “post-baby body transformations” touted in the tabloids, there’s a growing groundswell of women on social media who are intent on sharing what a real life body that’s recently made and birthed a human being actually looks like, without a filter in sight. One such woman is personal trainer and fitness star Emily Skye, who alongside sharing her experience of sickness and tiredness during her pregnancy, also posts pictures of her body and the way it has changed in a way that many women who’ve had children will relate to: surprisingly, women’s bodies don’t morph like Transformers into perfect replicas of what they were before. Emily accompanies her Instagram posts  with explanations of where her head is at:

“I loved my body before I got pregnant but I love it even more now. Isn’t the human body incredible?! What we’re capable of absolutely blows my mind. My body isn’t just supporting my own life but it grew a human - and still is! I’m so proud of what my body has done and continues to do for my precious daughter.

“Mothers are absolutely amazing and we should all be so proud of ourselves! Being a mother isn’t easy in many ways which I’m now starting to experience and the last thing I’m going to do is pressure myself to “bounce back” quickly or beat myself up because my body hasn’t returned to my pre-baby condition. It’s totally unrealistic for me to expect to “bounce back” from having my beautiful big belly to a flat and lean tummy in a short amount of time.

"I choose to celebrate my body and how incredible it is in any condition, shape or size and I choose to focus on being my best mentally and physically for my daughter Mia - and my priority definitely isn’t looking a certain way.”

There’s also kick-back in Hollywood as to the unrealistic aesthetic expectations placed on new mothers. Blake Lively  stated earlier this year that it took her “10 months to gain, and 14 months to lose” pregnancy weight (i.e, the healthy norm), while mother-of-two Olivia Wilde has flat out denounced all post-baby body scrutiny whatsoever:

“I believe in a world where mothers are not expected to shed any physical evidence of their childbearing experience...I don’t want to waste my time striving for some subjective definition of perfection.”

As for the post-baby tummy commotion in particular, three time mother Jennifer Garner isn’t playing ball with any of this “bouncing back” business, as she stated to Ellen DeGeneres:

“From now on I will have a bump, and it will be my baby bump. It’s not going anywhere.”

Given that women have been giving birth since the dawn of time, it seems farcical that our modern culture still cannot comprehend that we don’t snap back like wind-up toys- the furore after the Duchess of Cambridge appeared on the steps of the Lindo wing with bump intact mere hours after giving birth to Prince George highlights the sheer imbecility of society’s apparent expectations (and ignorance). Having a baby is a transformative process for womens’ minds, lifestyles, careers and entire bodies, never mind our stomachs. The fact that women sharing what theirs actually look and feel like after giving birth is considered revolutionary is telling of how little is understood about women’s bodies as well as how society values women. Your tummy isn’t a pop-up baby tent, as it happens, and pregnancy can have all kinds of effects on your core. Looks aside, here’s the deal on what your midsection has achieved throughout pregnancy, how to strengthen your stomach muscles afterwards and when you might need specialist help. Not a ‘circle of shame’ in sight.

How your abs change in pregnancy

Firstly, they move, because the consequences would be dire if they didn’t, as Women’s Health Physiotherapist Clare Pacey  explains:

“In pregnancy, the tissue that connects the two muscles that run down the centre of your stomach (known as the linea alba) will thin and often separate, allowing a mother’s abdomen to stretch to accommodate a growing uterus; it is a natural part of pregnancy and essential to allow the baby to grow in a closed space without crushing your organs.”

A growing stomach also more often than not requires some time and space to settle on a psychological level too: if you’re used to hitting the gym and nailing reps of ab crunches, you’ll need to relax that to give both your baby and body space. That’s not to say that you need forgo your workouts all together (check out these ideas for exercising in pregnancy ), but Clare has some pointers in the ab department:

“We need a lot more research in this area but during pregnancy I would recommend avoiding any activities that cause the abdomen to bulge, to stop sit ups once the uterus comes above the pelvis brim (around 12-14 weeks), to minimise twisting and overhead activities, particularly if you have a diastasis, and to maintain good alignment.”

Translation time: a diastasis (often termed diastasis recti or divarication) refers to a seperation of your abdominals. You may notice a bulge where your stomach muscles have come apart, but equally you might not. As for maintaining good alignment, this is essential for men and women no matter their life stage, but particularly pre and post pregnancy, as Clare underlines:

“The number one piece of advice I can offer any woman is to be aware of their alignment is and to maintain it as best they can throughout pregnancy and beyond. This is also a vital part of correcting a diastasis. Standing, sitting and moving about in a lousy position all day can keep the abdomen separated.

“Many women lean back as their tummy grows during pregnancy and often this continues postpartum, too. Take a look in the mirror - Is your rib cage too far back, are you breathing with your upper chest, is your pelvis tucked under?

“If so untuck your bottom and shift the ribcage over the top of the pelvis. This is the optimum position for the pelvic floor and gluteal muscles to activate.

“Remember to be conscious of your alignment when exercising too. Exercising in correct alignment will promote a better result from your fitness program.”

Keeping alignment in check and following the ab exercise guidelines as outlined above can, according to Clare, decrease the presence of a postnatal diastasis by 35 per cent. If you’re post-birth, however, there’s still heaps you can do to strengthen your stomach muscles and protect your lower back, and be aware that some degree of diastasis is normal- it's especially common if you've had multiple pregnancies or had twins or triplets.

Post-baby abs

First things first, give yourself time to recover from the birth, and bear in mind that a little ab separation doesn’t necessarily mean that you have a diastasis:

“Approximately a third of women remain abnormally wide at eight weeks postpartum onwards. Many women think that the presence of any abdominal gap means that they have a pathological diastasis, but this is incorrect. Your abdomen needs some ‘give’  to open and close as you breathe, and we all appreciate that gap after a big meal! So some degree of a gap is normal and natural. The key is how your abdomen is functioning and how well the sides of the abdomen are communicating with one another through the gap and fascia (connective tissue).”

You can monitor the size of your ab separation, and whether it’s decreasing, by using the following NHS recommended technique:

• Lie on your back with your legs bent and your feet flat on the floor.
• Raise your shoulders off the floor slightly and look down at your tummy. Using the tips of your fingers, feel between the edges of the muscles, above and below your belly button. See how many fingers you can fit into the gap between your muscles.

To encourage your abs to “knit” back together, Clare recommends conquering the basics:

“Don’t underestimate the power of efficient breathing. I encourage my clients to gently squeeze their pelvic floor muscles  and exhale out prior to movements, such as lifting their baby. This activates the inner core. Continuing this exhale throughout the exertion will help to protect and maintain diastasis closure throughout the activity. It also prevents you holding your breath, which causes an increase in abdominal pressure and can make diastasis worse.”

As well as breathing, natural hormonal changes after birth could also help to reduce abdominal separation, enhancing your gym work, although the NHS advises only taking up exercise when you feel ready, and usually not before your six-week postnatal check-up. Personal trainer at women's health, wellbeing and lifestyle club  Grace Belgravia  Samson Garwood highlights the exercises to prioritise, and what to avoid:

“During pregnancy, hormonal changes can have a dramatic effect on your abs. Relaxin - the hormone produced in the ovaries - helps prepare the body for pregnancy by literally ‘relaxing’ the ligaments of the pelvis. This allows the separation of the abdominals from the fibrous tissue as the baby grows.

“Relaxin levels remain present postnatally for two to to five months, which can be beneficial in effectively bringing the abs back together. That said, if they do not return through correct training, this is known as ‘diastasis recti’. This can be resolved by a program of pelvic tilts and breathing exercises, although it is essential not to dome the muscles (hence crunches are out), as this exasperates the separation.

“A post-natal exercise programme should focus on re-toning and training your pelvic floor muscles , increasing abdominal muscle strength to enable your abs to support the spine and regaining correct posture.”

The NHS recommends the following exercise as a starter for ten for toning stomach muscles:

• Lie on your side with your knees slightly bent
• Let your tummy relax and breathe in gently
• As you breathe out, gently draw in the lower part of your stomach like a corset, narrowing your waistline
• Squeeze your pelvic floor muscles at the same time
• Hold for a count of 10, breathing normally, then gently release
• Repeat up to 10 times

Post-natal exercise classes

If you’ve ever considered investing in a course of PT sessions, now could be the time, but be sure not to opt for any old cowboy. Now more than ever, you need an expert in their field who’s trained in post-natal exercise and rehabilitation. In addition to prenatal maternity modification classes, Barrecore  offers postnatal adjustments and specialist diastasis sessions, in which you’ll work one-to-one which a trained expert to diagnose your degree of separation and tailor take-home exercises to suit, helping to heal the divide, strengthen your core and protect your back, preventing pain down the line. You’ll find studios in London, Bristol and Alderley Edge. If you’re London based, Frame’s Mumhood programme  also offers an abdominal specific post-natal class , helping you to safely reacquaint yourself with your abs and rebuild you abdominal wall. It’s a mat based class with small numbers for as much personal attention as poss, plus you can bring your baby along with you.

What to do if exercise, posture and breathing techniques aren’t bringing your abs back together

It’s been eight weeks, and still your abs aren’t reunited. Clare runs us through your options:

“Improvement has to do with the bodies’ capacity for fascia recovery  and the willingness of the individual to change how they are using their body, but we’re all different, and unfortunately it’s not always easy breezy.

“Dealing with diastasis recti isn’t straightforward and there is no set protocol for all women. Generally it requires individual assessment of the deep central stability system (consisting of the diaphragm, transversus abdominis, multifidus , and pelvic floor). This area creates tension over the connective tissue and regulates abdominal pressure. A personalised progressive exercise programme to rebuild the abdominal wall can restore optimal function, and in some cases this may include bracing or taping when appropriate.

“Your ability to perform an abdominal activity also needs to be assessed. The overarching rules that I set for my patients are that if you lose your breath (and need to hold it), or if your alignment is compromised during an activity, it is too challenging, and might do more harm than good.”

If physiotherapy isn’t helping, your next steps could be surgical:

“For some women, physiotherapy is not sufficient and a surgical abdominoplasty is necessary. As an example, this would be appropriate for a woman who has completed her family and is one year postpartum, who has tried a multi-tiered rehabilitation programme supervised by a physiotherapist but is unable to generate sufficient tension through the abdominal wall for resolution of function. Surgery should always be combined with a rehabilitation programme as an abdominoplasty will restore anatomical structure but not the abdominal muscle function.”

The vital thing to remember is that gaining strength and getting back to “normal” takes time- at least nine months. If you’re not seeing any improvement despite exercising regularly and eating healthily, seek an expert opinion and be sure to let your health visitor or GP know if your abdominal gap hasn’t begun to close in the eight weeks following birth. Be assured that Clare regularly helps women fix diastasis who are years beyond their last delivery- take it gently and bear in mind that the gym will always be there.

Book to see Clare at  www.clarepacey.com  and follow her on Instagram  @womenshealthbyclarepacey

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