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.

A Healthy Pregnancy Diet: Part Four

Smart Sexy Birth Blog

Last but not least is our final installation of the Healthy Pregnancy Diet series.  We are talking the five core essential nutrients that lay the foundation for a tip-top healthy pregnancy, birth, baby, and postpartum experience.  If you didn't catch the earlier ones you can find Part One here, Part Two here, and Part Three here.


Omega 3’s are a family of fats made up of three essential fatty acids: ALA, EPA, and DHA.

The human brain is about 60% fat, and basically it takes fat to make fat.

One of these fats that plays a particular role in brain makin' is DHA.

In the last trimester babies brains grow by four or fivefold, and DHA is the lady in charge of all that happening.

"Your baby is literally pretty much sucking you dry of your DHA reserves and he/or she will continue to do so even after birth through breastfeeding when brain growth is moving in the fast lane."

Your breast milk is only as good as your diet is.

So if you want to pass on Omega-3’s in your milk you gotta eat em'.  Also, it’s not just the quality of your milk but also the quantity as Omega-3’s play a crucial role in making breast milk to begin with.  Women who are deficient often have issues with low milk supply. 

Once again takes fat to make fat.

Going even further, Omega-3 fats not only affect your babies, brain but it also effects YOU!

You have a brain and body that need essential fatty acids to function as well!

Women who are low in Omega-3’s have shown a sixfold greater risk of developing postpartum depression as well as obsessive compulsive disorder and this risk can hang around even two years after the birth of your child. 

Life is difficult enough.  Life with an infant is difficult enough.  And life with an infant and postpartum depression is heart wrenching.

Obviously PD can show up regardless of diet, but to know that we can do something to decrease our risk for it should be at the top of our priority list.

We know that with each pregnancy you have, you get depleted in your Omega-3's. So if you don’t put some effort into replenishing yourself after baby, the next pregnancy will deplete you even more. 

We also are beginning to see that these things may be passed on. So if your mother did not have enough DHA, she passed that onto you.  If you don’t do anything about it, you pass even less onto your daughter and she comes out and continues the cycle with her kids.

Single best way to get your Omega-3's in is by eating fish 2-3 times a week.

Countries that have high consumption of fish like Finland, Iceland, Norway, Sweden also have some of the best infant and maternal mortality rates, smoothest labors, and lowest postpartum depression issues.  Obviously that’s correlation not causation BUT something to take note.

We have a bit of a fear with fish in this country because of the mercury issue.  There are fish that you should avoid.  They are tilefish, swordfish, shark fish, blufin tuna, and king mackerel.  But don't let that dissuade you!

There is way more of an assortment that you can choose from compared to those that you can't.

Top picks are wild salmon, trout, halibut, and sardines (canned or fresh).  You can find a handy dandy wallet sized cut-out, listing all the fish do's and don'ts, in our Perfect Pregnancy Nutrition fun sheets (sign up below).  Pop it in your wallet and whip it out for easy reference when shopping or eating out.

Bottom line is: you need to get smart about your fish but don't shy from it completely.

In fact the importance of Omega-3's on fetal brain development have become so apparent that the FDA and EPA have recently revised their previous recommendations of throwing caution to pregnant women about eating fish to actually encouraging them to get at least 8 ounces of low-mercury fish in per week. 

All in all I think it's fair to say that there was a real reason why primitive cultures back in the day would go to great lengths to get access to fish products just to bring back to their childbearing ladies in the village. They knew it was vital to a healthy pregnancy and baby! 

If you don’t like fish, no way no how, get your hands on a quality Omega-3 supplement.  I always say nothing beats the real thing, but it's better than nothing.

So that's it!  Get your Calcium, Protein, Vitamin D, Folate, and Omega-3's in every day and you will be well on your way to rockin' this pregnancy thing out!

Isn't it amazing to see how powerful our food can be?!




Posted on August 3, 2015 and filed under PREGNANCY.

A Healthy Pregnancy Diet: Part Three

Smart Sexy Birth Blog

I've said it before, I'll say it again, a healthy baby and mama all start with the foods on your plate! So lets continue on and hatch out Part Three of the 5 Core Essentials to a healthy pregnancy diet.

In case you missed the first two, catch up on Part One here and Part Two here.  


When you eat protein, your body takes it and transforms it into amino acids.  We say that cells are the building blocks of life, well amino acids are the building blocks of cells! 

Every square inch of that cute little babe in there is made from protein.  So if we want our kids to have good strong cells, we need to get good strong protein.

Most of us think of meat when it comes to protein sources, but there are also many plant-based sources as well.  I give an extensive list on one of the fun sheets you can download for free over here (password: bodaciousbabes) but some examples are avacados, beans, nuts, and wild rice.

The key to plant-based protein is food combining.  We will get into the details of food combining in a later post but just know that animal products are what we would call "perfect proteins" because they contain all the amino acids.  Plant-based sources, however, are not perfect proteins by themselves.  Hence the ol' rice and beans combo is there for a reason!  


As we all know calcium is a major player in bone formation, but it also is a key player in a good working heart for your baby.

If you don’t have enough reserve of calcium, the placenta is gonna start sucking it from your own bones.  If you keep slacking on the calcium and continue having kids you can probably bank on osteoporosis sooner rather than later.

In an interesting twist if you breastfeed there is evidence that you will actually make your bones stronger….even more stronger than before you got pregnant!  Kinda cool to think.

We still don’t know all the things that calcium does, but we do know that normal adults usually absorb about 20 % of calcium from their diets- because that’s all we really need. 

Pregnant chics absorb 60% in the second tri and up to 70% in the third!!

So obviously your body knows it’s useful for something!

It has been ingrained in our heads to think of milk whenever we think of calcium but we actually don't absorb the vitamin that well through milk.  Single best resource is the abundance of leafy greens out there.  Think collard greens, mustard greens, swiss chard, spinach, kale, etc.

So, what can you do today to get your protein and calcium in?  Share your ideas below!  

See ya in Part Four tomorrow for the finale!

Posted on July 31, 2015 and filed under PREGNANCY.

A Healthy Pregnancy Diet: Part Two

Smart Sexy Birth Blog

Continuing on in our four part series (catch the first one here), we are talking the 5 core essential nutrients for a healthy and vibrant pregnancy.

Vitamin D

Most of us know vitamin D as the sunshine vitamin, right?

So what does Mr. D do?

Well, all that calcium you’re munching on cannot be absorbed without good ol' Mr. D.

No vitamin D equals no calcium absorption.

Another cool thing to know is the only way your baby can absorb the calcium found in your breast milk or formula is by getting enough vitamin D in utero.

“The only way your baby can absorb the calcium found in your breast milk or formula is by getting enough vitamin D in utero.”

Crazy pants right?

If you don’t pass on enough while baby is growing in your belly, he can possibly come out deficient in vitamin D which can mean:

  • Low birth weight.

  • Poor growth

  • Bone fragility

  • AND they have even found that babies born deficient in vitamin D have a higher incidence of immune diseases.

On the pregnancy side we have found that women deficient in vitamin D have a higher chance of gestational diabetes, preeclampsia, and higher incidences of postpartum depression.

It has become more and more prevalent that kids are coming out low in D that if you breastfeed or partially breastfeed you will probably find your pediatrician recommending you to give your baby a vitamin D supplementation during his infancy.  (Formula is fortified with D so it’s not necessary to supplement.)

But here is the thing: if our babies are low in vit. D it means our mamas are low, and we need to be taking care of them too.  If we get our mothers levels up, our babies levels will be up naturally, plus our mothers health will be better off for it!  It’s like killing two birds with one stone.

So why are we not addressing it yet in pregnancy? Well long story short, the obstetrical world recognizes that the problem exists but they can’t come to an agreement on how to go about it.  How do we test?  Do we make it standard for everyone?  How do we treat it, etc.

The pediatric side seems to be a little bit more organized.  Sooooo while we wait for the medical community to get with it, we are just gonna have to take matters into our own hands!

There are a few food sources that provide ample Vit. D, but the single best way to get it is to get your butt outside and get some unprotected sun and fresh air.  Good for your health, good for your soul. 

You gotta skip the sunscreen though.  It keeps the D out. About 20 minutes will do for fair skinned gals and about 30-40 minutes for darker skinned mamas.

Go out and get your Vit. D today!

Take a look at Part Three here.


Posted on July 30, 2015 and filed under PREGNANCY.