Posts filed under MOTHERHOOD

Is That After-Baby Tummy Bulge Actually A Diastasis Recti?

Smart Sexy Birth Blog

So you've had baby, you are a few months postpartum and you still feel like you look 4 months pregnant?

Or maybe you've already gotten back into an exercise routine and it just seems like no matter what you do that tummy is not going back in like it used to be?

A permanent fixture of a pregnancys toll on your body? Maybe.


There is a silent epidemic hitting postpartum women all over the U.S and it's called a Diastasis Recti, a condition where the front surface muscles of your belly seperate.  

I called upon renowned expert Melissa McElroy, PT, DPT, a trained Physcial Therapist from Bellarmine University who specializes in Women's Health and Male/Female Pelvic Dysfunction to fill us in on how to tell if you have a Diastasis Recti and what to do if you suspect it.

So what exactly is Diastasis Recti and what causes it?

Diastasis Recti (DR) is a separation of the rectus abdominis muscle (think 6-pack muscle) midline down your abdomen, causing stretching and compromise to the connective tissue surrounding it. In general, this stretch and separation is caused by continuous or chronic repetitive pressure or force on the structures/ increased tension on the abdominal wall. This occurs in pregnancy, with increased incidence into the 3rd trimester when prolonged forces against the abdomen are greater.

Image courtesy of Wendy Powell at

Image courtesy of Wendy Powell at

What problems can occur if left untreated?

One of the primary functions of the rectus abdominis muscle and its associated connective tissue is support and compression of the abdominal organs as well as counter-balancing the muscles of the back. If left untreated, a DR can lead to chronic low back pain, pelvic organ prolapse (bladder falling, uterus falling), incontinence and hernias, as well as pelvic instability and increased incidence of pain with subsequent pregnancies.

How often do you see it in your practice and why do you think it has become so common?

Almost everyone who comes into our clinic (male or female) is tested for a DR because it is extremely common. I don’t think that there is necessarily an increased incidence of DR compared to 5/10/20 years ago, but I do think that it’s finally being given the attention that it desperately deserves.

So you are saying it has always been an issue for women, but that we have lagged in addressing it postpartum?

Yes.  This is one reason why I'm seeing women who's children are older/grown who come in due to prolapse issues; because their DR was never properly addressed.

Why is there such a massive gap in screening for it postpartum?

I feel that post-partum care as a whole is lacking in the US. As a society (medical and otherwise) we shift our focus to baby as soon as he/she arrives, often forgetting that the mother’s body went through a wonderful but traumatic event to bring baby into the world.

How do you know if you have it?

There is a simple test that can be easily performed at home. It can be done on your own, but it’s highly recommended that you have a friend or significant other perform the testing instead.

The patient lies on her back with knees bent and feet resting on the ground. The tester (friend/family member) places his/her fingertips into the belly button with their hand perpendicular to the abdomen. Then the patient is asked to raise her head off the ground while reaching with her hands towards her toes.   A measurement is given based on how many fingers fit between the ridges that the abdomen makes when the patient raises her head. The test should be repeated above and below the belly button as well.

A positive DR is a measurement more than one fingertip’s width. Research is varying when determining how many finger widths should be considered “significant”. My thought is, if you’re worried enough to be testing yourself then you may just want to get things checked out by a professional.

If a woman suspects it, what should her next step be?

First and foremost, DO NOT TRY TO DO CRUNCHES. This will NOT, I repeat, will NOT help. It will most likely make it worse. If you suspect that you have a DR then find a physical therapist that treats it and go in for an evaluation.

What are some of the things that a woman should do, or more importantly, should NOT do, day to day?

Like I said before, your typical ab exercises (crunches, sit-ups, leg raises) could make your DR worse, so please don’t do them! (Obviously, if you are under the care of a licensed medical provider who is familiar and experienced treating DR and they have you performing a plank or leg lifts then maybe you’ve advanced to where its appropriate. For most of us, however, just stay away). Other day-to-day activities that you should be paying attention to are getting in and out of bed, getting in and out of a car, throwing laundry in the dryer, lifting the kids, lifting anything with weight to it. No forceful bending, raising up (like out of a recliner) or rotation. The general rule of thumb is, if your belly bulges when performing the activity then it needs to be stopped or modified so that there is no belly bulge with activity.

Is there anything a woman can do to prevent DR while she is pregnant?

Gernerally, the better core control/core strength you have prior to pregnancy and the more you work your core muscles (with appropriate exercise) during pregnancy the better off you will be. Does this mean that if you have a 6-pack before pregnancy that you won’t develop a DR? NO. Does this mean that you won’t get a DR if you work out daily during your pregnancy? Sorry, No. But you will be more apt to better rehab and recovery.

Is there an online resource a woman can use to locate therapists who specialize in treating Diastasis Recti in her area?

The American Physical Therapy Association’s Website: has a “Find a PT” page that you could search for a PT who specializes in Women’s Health. That would be my first recommendation. However, there are a lot of PTs who aren’t listed in that database, so my next recommendation would be to talk with your OB/Gyn or local general PT to see if there is anyone that he/she recommends.

Thank you so much for sharing your wisdom with us Melissa!  If you are in the Louisville, KY area and would like to make an appointment with Melissa you can find her at Dunn Physical Therapy.

For more information and some visuals on how to test and what it looks like check out:

So ladies lets spread the awareness!  Post this to your FB page through the link below and make sure all your girlfriends read it!

I want to know from you! Had you heard of DR before and did your ob or midwife check you for it postpartum?

Hugs and kisses to you all!




Posted on August 10, 2015 and filed under POSTPARTUM, MOTHERHOOD.

The Single Most Important Thing You Need To Have A Baby


It’s not the birth plan, the Hypnobabies cd or the doula.

What you need is simple.  Is deep.  Is even more important than finding a midwife or ob that practices evidence-based medicine.

What you need is RESPECT.

The greatest misconception in our culture right now, the one that has been fueling the flames of the birth wars, is this idea that the definition of having a great birth experience has to do with the tangibles, meaning with things that we can see with our eyes and hold with our hands. 

One party of the debate likes to define a good birth as one that plays out with the most minimal technological intervention.  Less drugs. Less machines.  Better and safer birth. 

The other side declares that the best birth comes from the opposite.  More drugs. More machines.  Better and safer birth.

All great discussions. But missing a crucial point.

“If your obstetrician or midwife treats you like shit it is not going to matter whether he or she practices evidence-based care or not.”

You go out into the Internet world and read any of the stories of unpleasant birth experiences and what do you see as the underlying commonality between them all?

That the woman didn’t feel supported, that she felt belittled, invisible, disrespected, violated, unheard.

It did not have so much to do with what was done, but how it was done.

A cesarean that a woman feels bullied into or one where she feels ignored and completely disregarded during the process is an entirely different experience of one that is approached as the mother being an equal partner in the decision making process as well as the most important, involved member of the operating room.

Birth is more than stats and science.  Birth is a subjective, personal, mysterious, unpredictable, physical and soul exploding moment in time.

Birth is whatever it is to the woman who is doing it.

Before we begin spreading the word of evidence-based practices we must first make sure that we are working from the most fundamental element of good medicine: human decency.

What do you get when you feel respect? Trust. What do you get when you feel trust? Feelings of safety.  What do you get when you feel safe?  Open.  What do you get when you feel open?  The ability to surrender.  What do you get when you can surrender?  The ability to birth and embrace whatever the journey of childbirth brings to you.

Respect is the foundation for which all of this as well as the integrity of science can unfold.

If your doula doesn’t make you feel these things, she’s out.  If your midwife or obstetrician can’t bring these things to the table during your prenatal appointments, fire them.  What makes you think they will act any differently on delivery day?  If your family members or well meaning friends cannot step up to the plate, do not invite them to the birth.

I don’t care how long or crazy of a day it has been for them.  They are there for you, not themselves.  And the ones who are, quite frankly, not mature enough to muster that up for you should be put out of business.

Respect is not something that comes out of having a fresh night of sleep or a seamless day.  Respect comes from the acknowledgment that you are a human being and that it is your God given right to be treated like you matter because you do. 

You are not just another pregnant woman.  You are not just the twelfth delivery of the day.

You are the life giving force of humanity.

Respect first, science second.  Period.

Love and light your way,


Next post will be a little checklist on how to tell if you and your care provider are the “right fit” for each other.   Until then I would love to hear from you!  What are your thoughts and experiences on this issue?  How would you define a great birth experience?


Posted on April 21, 2015 and filed under MOTHERHOOD, PREGNANCY, CHILDBIRTH.