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Wrong diagnosis of Diastasis recti

I have been motivated to write yet another blog on this subject after the poor testing by a midwife on my client.

I’m not sure how many post natal women are aware of diastasis recti- abdominal separation.

Diastasis recti is a condition where the two right and left sides of the rectus abdominis (your "six-pack" muscle) spreads apart at the body's mid-line (the linea alba). Separation occurs in response to your uterus pushing against the abdominal wall and pregnancy hormones soften connective tissue. Separation can occur at any time in the last half of pregnancy but is most problematic after pregnancy when the abdominal wall is weak, when there is no longer a baby inside to aid support.

As separation occurs during late pregnancy women who give birth prematurely before 33 weeks may have minimal separation were as women who carry up to 40 weeks, carry a multi and are not aware of posture or the benefits of exercise can increase the separation during their pregnancy.
Many women aren’t aware of the separation occurring as you feel no symptoms or pain during pregnancy it is only when baby is out that many women start to suffer from lower back and hip pain or notice many months late that they can’t get rid of their post baby tummy.

My client had a 2nd emergency C section and after being recommended by her specialist to wear a surgical belt for 2 weeks post her midwife tested her separation at 3 weeks post operation and said she was fine. I had my doubts but my client was very happy so I didn’t want to disappoint her just yet.

It was the following week at 4 weeks post baby that I tested her. She had a 6-7 cm vertical gap and a 3 cm horizontal gap. Her midwife had completely misdiagnosed her separation, fortunately for my client she has me as her trainer so has now been recommend to do the correct exercises to re-hab her correctly and she should have minimal if any gap in 6 weeks.

If my client was not under a post natal specialist after the diagnosis from her midwife she had the right to assume that she could go back to any form of exercise and possible do exercises that can increase the separation.

Education and the correct testing of this condition is the key. If you exercise correctly and have good post natal posture then you can decrease your diastasis recti completely. If you do the wrong exercises such as planks and crunches, continually hold poor post natal posture, push a buggy with poor form and technique then you are setting yourself up to have lower back pain and a tummy that won’t go away. Along with a gap in your tummy that could still be there 5 years later.

I am not suggesting that all midwives wrongly diagnose this condition what I am saying is that your midwife or LMC needs to correctly assess if testing you for diastasis recti. If in doubt get checked by a professional or contact me for further advice on testing for separation

12 week post natal exercise programs which include exercises to decrease diastasis recti and correct poor post natal posture available on my website http://pregnancyexercise.co.nz

When and How Can I Exercise Post a 'C' Section

It is crucial following a 'C' section that you allow your body to not only recovery from your pregnancy but also from abdominal surgery.

You have just had major surgery and depending on how your baby was delivered may also affect your recovery.

If you elected or had to have an elected ‘C ‘ section your body has not naturally gone into labour so your body may still be in shock post the operation. It still thinks you are pregnant!
Due to an elected ‘C’ you can rapidly gain fluid as your body tries to protect itself from the stress, your breast-milk may not come in as quick and your baby may struggle to latch on.

If you have gone in to labour and then had to have and emergency C section your body responds better post as it had gone into labour naturally. Your brain and body had registered that the pregnancy was over.

In the days that follow a ' C' you can be in minimal to quite a lot of pain. You unfortunately need to take many pain killers during the first 1-10 days. You should not have increasing pain from days 4-5 post you should at this stage be able to move around easier. This is normally when you are allowed to go home.

If you exercised during your pregnancy you are now at a huge advantage you will recover quicker up to 80% quicker than women who didn’t exercise.
You can use your upper body and leg strength to lift you up out of bed or a chair, avoiding using the tender, sensitive area where your stiches are.

The first exercise you need to do when leaving hospital, if you think about it and you have minimal pain.
Have a look at your tummy muscles and see if you can activate your abdominal muscles this is a very simple activation exercise.
See if you can pull your belly button in towards your spine activating your T.V.A-transverse abdominal muscle and rectus abdominal, just gently, no quick and fast pull ins. Just see if you can do it slowly. Avoid trying to contract all the way in, just a little is all you need to do. You should feel no pain. You should not be activating any other muscle or tilting your pelvis underneath you.
If you do feel any pain try the activation exercise 1-2 days later.
For more information on how to connect with your T.V.A muscles post birth go to http://pregnancyexercise.co.nz -articles

Try to do this early activation exercise each time you lift your baby up, when you change and carry them.
From 2-3 weeks post you should try to activate your tummy muscles as often as you can.
You should not feel any pain. At this stage you are ready to start a Post Natal Corrective exercise Program. Around 2-3 weeks post if exercised during pregnancy 4-6 weeks if not.

You may feel you are ready for a walk from days 10-14 depending on the exercise you did prior to birth but if you are still sore it may take another 7-10 days. It could take another 4 weeks if you are unfit from lack of exercise or bed rest.

Walking Post ‘C’ Section
Go for a small 10 minute walk by yourself not with the buggy from 2-3 weeks post if you have no pain! You can add the buggy from 4-5 weeks on the flat if you follow a rehabilitation program like the 12 week post pregnancy program I offer http://pregnancyexercise.co.nz/

This is the walking program I recommend following a C section:
Walk by yourself from day 12-21
Start with 10 minutes. If you feel ANY pain stop, try again in 2-3 days. If you have no pain you can repeat 48 hours later. Repeat the same walk time 3 times, each time leaving 48 hours between. If after the 3x 10 minute walks there is no pain you can increase your time by 5 minutes and then repeat the program. So walk now for 15 minutes every other day and do the same time 3 times. Again adding 5 minutes after every 3 walks of the same time.
Do this until you are walking 3-4 times a week for 45 minutes with no pain.
This walking program is just walking. It is not exercise and there is minimal effort required it is just a WALK.

Once you can walk pain free for 30 minutes 3-4 times a week you can try to push your baby in a buggy. If you are less than 8 weeks post take it easy and try to stay on the flat. It is a good idea if you can go with a friend so they can take over on the up and down-hills. It is hard to push your baby up-hill as this puts a huge strain on your core muscles and down-hill is just as hard as you have to try to stabilize your buggy with weak muscles. Try to avoid.

After 8 weeks you can increase your walking pace and intensity, don’t go out and walk fast for 45 minutes, you need to build slowly. Try 10 minutes at 70-75% Intensity -aerobic intensity exercise, you know you are exercising but you are not pushing yourself too hard- If this feels ok and you experience no pain try 20 minutes fast on your next walk and then try 30 minutes the following week.
You don’t need to walk hard on every walk, try to do 3 walks a week when you walk faster and at a higher intensity.

Strength Exercise over Cardio Post C section?
Your strength exercise is more important than your fitness. It is just nice to get out of the house and be pain free which you can now do if you follow the walking program.
You can and need to do a specific strengthening exercise program 3-4 times a week post a C section. If you can do this you would be back to full core strength within 14-20 weeks depending on when you start a program. A good program will decrease abdominal separation, increase core and glute strength and focus on postural muscle strengthening exercises.

The benefit of not pushing your baby out is that your pelvic floor muscles are probably ok! You still need to do your pelvic floor muscle exercises post birth as they have been weakened with the weight of your uterus.

Please feel free to comment and ask further questions. This is just a short guide.

If you want to purchase your own specific and safe post pregnancy 12 week program please contact me for a FREE 2 week Trial Lorraine@pregnancyexercise.co.nz
Remember the golden rule. You need to check with your G.P or LMC before starting any exercise program.

Mel B- Eating for England

Headlines today August 2nd is Melanie Brown aka Scary spice is “Eating for England” during her 3rd pregnancy.

Mel admits she has put on a whopping 64lbs which is 29kg. This is reported not to worry her as she knows she is active and will be able to get the extra pregnancy weight off.
http://tvnz.co.nz/entertainment-news/mel-b-eating-england-during-pregnancy-4336017

What are your thoughts on this?

Here are mine:
Firstly she has put on a lot of extra pregnancy weight and may have increased her chances of developing gestational diabetes with such rapid weight gains.
She may have also increased diastasis recti-abdominal separation and increased her chances of developing stretch marks. These are just 3 reasons why not to put on extra pregnancy weight.

I don’t think this is a good advert for other pregnant women. Although on the other hand we generally see the opposite of stars, so which is best? We need to see the middle ground more often as I know women are influenced by the stars.

Mel B may have also started off at a lower weight than most women and if she was underweight at the start of her pregnancy then she may have not packed on as many extra kilos as the recent article suggests?

Women have to remember that Mel B is normally active and will have lots of professional help after the birth of her baby. So although it will not be easy for Mel to lose the extra weight, she will have many helpers.

What do you think, has Mel B put on too much weight?

3 Must do Exercises Post Pregnancy

Why is post pregnancy exercise so Important?
If you do not do corrective exercise post pregnancy then you have a very high chance of developing lower back and hip pain and you will find it almost impossible to correct diastasis-recti abdominal separation which happens during late pregnancy. You will also find it harder to lose your baby tummy.

After the birth of your baby you no longer have your baby inside to support you. You need to activate the muscles around your torso for support and sooner rather than later.
If you leave it for too long it becomes much harder to activate the weakened muscles. These muscles support you, you need them and you need them to be strong.

You cannot hold good posture with weak core muscles.
Poor posture alone is enough to increase back pain and stop you from seeing results around your mid-section. The exercises will also help with your post pregnancy posture.

Doing the exercises below and following the full 12 week post pregnancy exercise program could save you a fortune in physiotherapist and doctors’ fees!

Unless you have had a ‘C’ section you can start these exercises 4-5 days after giving birth. If you have had a ‘C’ section you can visit my website for more info or contact me Lorraine@pregnancyexercise.co.nz . I normally suggest to start exercising 3 weeks post a 'C' but activation of the T.V.A muscles is needed before that. I have more post natal exercise guides on my website: http://pregnancyexercise.co.nz

Exercise 1: Lower abdominal activation: 4 Point Kneeling

The 1st Exercise you need to do post pregnancy is Activate your T.V.A muscles-transverse abdominal.
The best way to activate the muscle is in this 4 point kneeling position:
Hands shoulder width apart and knees hip width, maintain neutral spine as in the photograph.
Now completely relax your tummy muscles, let them hang down but don’t relax your good posture so don’t sink into your shoulders. This position helps your brain activate the weakened muscles.
Next draw your belly button up-towards your spine, do this very slowly. Can you feel your tummy muscles working? You should feel and see your tummy lift up and feel your waist narrow slightly. Try to hold for 3-5 breaths then relax your tummy back down. Repeat this 3-5 times and do 2-3 times a day. You can do this exercise whilst you’re changing your baby on the floor or playing with them.

Don’t forget to think about your posture during the day, activate your T.V.A muscles every time you pick your baby up or carry them. More information on how to activate your T.V.A muscles: http://pregnancyexercise.co.nz/information/post-natal/how-soon-can-i-exercise

Side Leg Raises

Exercise to strengthen weak hip stabilizing muscles-Gluteus Medius
This exercise is simple to do however you need to get this exercise right so you target the weak muscle and don’t use the stronger dominant leg muscles -your quadriceps. It is best before commencing this exercise that you perform a leg stretch. I suggest a side lying quadriceps and I.T Band stretch. Stretching a dominant muscle puts that muscle to sleep for a short period so you can activate the weaker muscle a little easier.

Exercise: Lying on your side stretched out. Bottom leg underneath you is bent for support lift the top leg up, lifting it backwards slightly. Keep your hip bones vertical as you lift making sure you are activating your T.V.A, abdominal and oblique muscles to stabilize your spine. Place you hand on your glute muscle so you can feel the muscle activating. Don’t feel this exercise in your quads-the front of your legs. Lower down and repeat 8-10 times completing 2-3 sets. Don’t do more if you are using the wrong muscle group. With good form and technique less is better.

Hip Extension

Exercise will target Core muscles and glutes
Activate your T.V.A muscles, rectus abdominal and oblique’s. Place more of your body weight into your heels. Push through your heel and lift your hips up. Keep your hip bones level.
You should not drop your hip to one side, nor should you feel your hamstring muscles cramping or dominating the exercise. Lower back to the floor, you need to feel that you are using your glute-butt muscles
If you do feel the exercise in your hamstring muscle, stop and stretch

The 3 exercises above are just a sample of the exercises that are included in the Post Pregnancy 12 week Program that I offer on the website. The 12 week program is less than $4.20 a week and you can buy it on the site today http://pregnancyexercise.co.nz

Do the above exercises 3-4 times a week. This is just a brief guide so any comments or questions please post

If you feel any pain or discomfort whilst exercising, stop. If pain continues consult you L.M.C or G.P.
The information included in this article has been written by Lorraine Scapens: She is not able to provide you with medical advice; information is used as a guide. You cannot hold Lorraine liable in any way for any injuries that may occur whilst training.

Lorraine has 20 years’ experience training pregnant and post natal women. She is a Personal Trainer and Corrective Exercise Specialist http://pregnancyexercise.co.nz email: lorraine@pregnancyexercise.co.nz

Belly Belts? Should you wear Pregnancy Support Belts?

Let me tell you a little bit about my experience as a personal trainer and corrective exercise specialist.
During the 15 years I have trained pregnant and post natal females none of my clients have needed or required to use the pregnancy support belts.

What are they?

The belts are generally made of neoprene, a wide belt that fastens under your uterus.
The companies that sell these belts advertise that the belts offer support to your growing uterus, reduce back and hip pain along with decreasing diastasis recti-abdominal separation post pregnancy.
Belts can be bought off the internet and are known by many names such as belly belts, my smiley belt and pregnancy belts.
Physiotherapists and midwives can and will recommend the usage of the support belts.

What professionals should be doing is educating pregnant women on the importance of good posture and maintaining an exercise program. Prevention is a much better option.

Do you need to wear a belt?

You shouldn’t need to wear support belts during your pregnancy but if you have poor posture, have a job that requires a lot of time on your feet, have gained excess pregnancy weight, a multiple pregnancy, have had previous hip and back pain then these factors may require you to use a support. These factors however should not determine the use of the support belts.

Advised to wear a belt?

If you have to wear a pregnancy support belt then your midwife or physiotherapist should advise you to also do corrective exercise and avoid positions that increase your pain. There are many articles on my site http://pregnancyexercise.co.nz about the benefits of good pregnancy posture and the correct exercise to do.

You should NOT wear the belts for more than a couple of hours a day. This is due to the fact that your body will start to rely on the belt for support not your muscles with prolonged use. You are switching off your core muscles and you could weaken the muscles further with prolonged over-use of the belts.
If you do have to wear one LIMIT the time wearing the belt and do your exercises to prevent the condition from getting worse. Long term use of the support belts can deactivate your muscles this could make your back and hip pain worse!

Poor Posture and weak abdominal muscles can reduce how efficiently you carry the weight of your uterus. The strain of a big baby, a multiple pregnancy and excessive weight gain during pregnancy can increase hip instability and abdominal separation.
If muscles are weak and overstretched they can no longer do the job that they are supposed to do which is support you. So another support is required, a belt!

What can I do to Prevent wearing the Support Belts?

It is extremely important during your pregnancy that you perform exercises that will engage the hip stabilizing muscles your glutes. The gluteus maximus and gluteus medius muscles must remain strong during pregnancy to reduce excess pelvic instability. Pelvis instability causes many problems such as SPD-Symphsis pubis dysfunction, Sciatic pain, Hip and lower back pain: The blog I wrote in a previous post explains more on lower back and hip pain associated with pelvis instability: http://positivelypregnant-mummytrainer.blogspot.com/2011/06/are-you-suffering-from-hip-and-lower.html

Why Is Corrective Pregnancy Exercise so Important?

If you exercise correctly with exercises that target your glutes and activate your core muscles with stabilizing exercises such as lunges, ballerinas and one leg hip hitches (NOT CRUNCHES or PLANKS) you should not have to wear the belts.
Try to avoid needing a belt by following a pregnancy exercise program and adopting good posture.

My Pregnancy Programs include all the exercise and advice you need to exercise safely and reduce back and hip pain during your pregnancy:http://pregnancyexercise.co.nz/services/alias

If you have any questions about this article please comment or Post on facebook: http://www.facebook.com/pregnancyexercise

Visit my website; http://pregnancyexercise.co.nz Email: Lorraine@pregnancyexercise.co.nz

If you feel any pain or discomfort whilst exercising, stop. If pain continues consult you L.M.C or G.P
The information included in this article has been written by Lorraine Scapens: She is not able to provide you with medical advice the information is used as guidelines. You cannot hold Lorraine liable in any way for any injuries that may occur whilst training.

The 10 Things you Need to Do Post Pregnancy

1 Activate your Lower Abdominal and Pelvic Floor Muscles
If you do not activate your T.V.A – Transverse abdominal muscle soon after giving birth and the weeks following it is much harder to activate these main core postural muscles. Meaning it will be harder to get rid of your pregnancy tummy and can increase diastasis recti-abdominal separation

2 Eat Food to increase Recovery from your pregnancy, labour and birth and to breastfeed
If you eat protein rich foods they will help you recover post birth, especially after traumatic births and ‘C’ sections. Protein re-builds cells and repairs muscle tissue so will help your body repair quickly. Try to have protein at each meal and snack. Try protein rich foods such as nuts, eggs and tuna.

3 Hydrate to rid the body of waste fluids and assist with breast milk production
Increase your fluids, it will assist your body getting rid of all the waste fluid post pregnancy and will help in the production of breast milk.

4 Posture: It has to be Good!
Look at your Posture, do it now. Poor post natal posture will lead to lower back, hip and knee aches and pains. It will also reduce how effectively you can activate your core muscles. Poor posture will also lead to increased diastasis recti. Have a look at this link for more information on post natal exercise, posture and diastasis recti:http://pregnancyexercise.co.nz/information/post-natal/post-natal-exercise

Poor Post Pregnancy Posture: Sway back

5 Rest
Simple enough but if you do not rest you will not recover and you certainly will not see any results from an exercise program. Rest every day even if it is just for 20 minutes.

6 Sleep
If you can get 6 hours + in a 24 hour period post pregnancy then you should be able to manage looking after a new born, yourself and exercising moderately. This dos depend on the individual though, everyone is different.
Avoid going to bed late and try to get back to sleep quickly after breastfeeding. Make sure you stay warm whilst nursing during the night and if you can lie down and relax during night-time feeds do so.This will help you fall asleep quicker.

7 Exercise
Post pregnancy exercise is crucial for recovery, it is a must. If you do not do post pregnancy exercises you are more likely to suffer from back pain and diastasis recti-abdominal separation.Exercise will help you get back to your pre-pregnancy shape.

8 Don’t try on your pre pregnancy clothes
If you are bothered by your post pregnancy shape, don’t try on your clothes. Remember you have just had a baby, it has taken 9 months for your body to change so don’t expect to get your jeans on just yet! Although for some it is very possible.

9 Stress
Try to relax during the day and enjoy your baby, if they can’t sleep during the day don’t worry put them in a buggy, put your I-pod on and go for a walk. Looking after two? Take them for a walk to the park. At night it is a little harder.
The more you are relaxed, the more your baby will be. If you are stressed you may retain your extra pregnancy weight for longer.

10 Enjoy being a mum
Sounds easy? I didn’t enjoy being a mum first time but second time I loved it. Yes there are many ups and downs but do what you can and be instinctive you can sometimes read too much. Do what you feel is right

Need a Post pregnancy exercise program? Have a look at my 12 week post natal exercise program it includes 12 weeks of exercise, 12 weeks of articles and many exercise descriptions. If you want to avoid and reduce lower back pain, ddecrease your diastais recti and get your pre pregnancy shape back then you can start this program as soon as 5-7 days post baby http://pregnancyexercise.co.nz/services/positively-pregnant-2



If you feel any pain or discomfort whilst exercising, stop. If pain continues consult you L.M.C or G.P. The information included in this article has been written by Lorraine Scapens: She is not able to provide you with medical advice; information is used as a guide. You cannot hold Lorraine liable in any way for any injuries that may occur whilst training.
Lorraine has 20 years’ experience training pregnant and post natal women. She is a Personal Trainer and Corrective Exercise Specialist http://pregnancyexercise.co.nz email: lorraine@pregnancyexercise.co.nz