How to Avoid Abdominal Separation During Pregnancy
I am now twenty weeks into my pregnancy and making big changes to my workouts. I have been looking for fresh ideas on YouTube etc. I might have to change my search terms because a lot of what I have found is contraindicated for pregnancy and can contribute to abdominal separation! Not good. This level of misinformation out there is what has motivated me to produce my own video for my YouTube Channel, which you can watch down below.
Luckily I came across abdominal separation very early in my teaching career as it was covered in my pre and postnatal qualification that I decided to do straight after my Pilates qualification in 2010. (It wasn't covered in my fitness or personal training qualifications in 2009 or my original Pilates training, despite the likelihood that we would be training new mums wanting to get into shape after pregnancy.) It has been something I have been studying ever since (This was my chosen topic for my research paper for my BASI Pilates certification.) as I do have women arriving in for class with the condition and I want to be able to give them the best possible advice.
How to Have a Shorter, Less Painful Birth
Plus a 30 minute Prenatal Pilates video!
So what is abdominal separation?
It's "formal name" is Diastasis Recti. Diastasis recti is the separation of the rectus abdominis (your “six pack”) muscles along the linea alba. I'm sure you have noticed that the tissues of the abdominal wall must stretch considerably to accommodate your growing baby. The mid-line connective tissue, the linea alba stretches lengthways and laterally, causing it to become thinner, weaker and less able to transmit load from the left and right side of the transversus abdominis and obliques. All women have this, in various degrees, at the end of their pregnancy.
If your abdominal wall cannot transmit load efficiently it can lead to back pain, pelvic pain and instability, discomfort at the linea alba itself and a more miserable third trimester. Who want's that!
For this reason, I am not going to try and train my abdominals while pregnant. I don't want to risk causing a larger separation than what will naturally occur. I have already cut out a lot of the exercises that I love doing because I can feel that they are not benefitting me and are slightly uncomfortable while doing them and the following day.
Who is most at risk during pregnancy?
- Those who gain more than the recommended amount of weight during pregnancy.
- Multiple pregnancies (twins, triplets, etc).
- Back-to-back pregnancies.
- Those who are older than 35 and pregnant.
- Those who perform incorrect exercises during pregnancy.
- Those who perform exercises with poor technique during pregnancy.
- Those who lift too heavy for their fitness level during pregnancy.
For general prenatal exercises guidelines you will enjoy my first post:
The Do’s and Don’ts of Exercising Throughout Pregnancy
Which exercises should we avoid while pregnant?
Any exercise in which your abdominal wall or pelvic floor cannot resist the increased intra abdominal pressure or gravity's pull. Any exercise in which you cannot maintain proper alignment, excellent form and breathing. An inappropriate exercise will cause the abdominal wall to bulge out further or pressure downward on your pelvic floor. If a separation is present a cone or a bread loaf shape will appear along your mid-line. Not the result we want to achieve!
Please note, some women will have the proportions and the required muscular strength to keep doing these exercises into their second trimester and some exercises all the way through. Remember that every woman's body and pregnancy is unique to them, the rules are different for every one. If you are unsure if an exercise is suitable for you, it is safer to leave it out as a precaution.
I suggest leaving out the following exercises in your second and especially the third trimester.
- Crunches, sit ups:
Avoid exercises which concentrically contract the rectus abdominis (RA). This muscle attaches from your breastbone to your pubic bone. It must lengthen the most during pregnancy, why would you choose an exercise which shortens it? Plus, where do you expect the baby to go when you flex your spine forward? A crunch generally displaces the internal organs slightly, increasing intra abdominal pressure. Our torso can manage this. However while pregnant, your growing baby increases your intra abdominal pressure, a crunching movement will further increase this and that pressure will bear down on your pelvic floor or onto your abdominal wall increasing the risk of a separation. If an abdominal separation is already present, a crunching exercise will cause the gap to widen! Some examples are crunches, reverse crunches, sit ups, in Pilates the Roll Up, Hundred and Teaser etc.
I also recommend avoiding any exercise which isometrically contracts the RA against a large force, especially when your bump/baby is bigger. This is an exercise which recruits your RA without flexing your spine forward. Some of these exercises are double leg lowers, single leg lowers, in Pilates the Double Leg Stretch, Single Leg Stretch and Hamstring Pull etc. In all of these examples the RA is stabilising your lower back against the pull of your legs weight. These will also increase the intra abdominal pressure which loads the abdominal wall and cause coning if a separation is already present.
A lot of videos contained standing crunches, which cause the ribcage to press inwards like a regular crunch, but do not work the abdominals but instead work the upper back. You can choose a better upper back or core exercise to use your time on.
I lost count of the many prenatal workouts on YouTube which correctly began with recommending that we avoid working the RA. Then the first exercises they recommend is Plank....which is intense work for the RA! As I already mentioned isometric contraction against a large force (in this case gravity) can be too much for the abdominal wall and pelvic floor to manage well.
Plus the horizontal position of your body will cause the weight of the baby to press forward onto your abdominal wall. This added weight coupled with the increased pressure is a recipe for separation.
- Push Ups:
A press up is a plank in which your arms also move (when performed correctly). The same reasoning applies.
- Strength training the obliques:
Your oblique muscles must also stretch to accommodate your growing baby. This causes the abdominal aponeurosis (the line down the sides of a six pack) to form a curve. When your obliques contract they will pull sideways and with that curve they will cause a diagonal pull increasing the pressure on the centre of the linea alba, your belly button. If you have read about Diastasis Recti you will know that a lot of women with it have a belly button that has not returned to "normal".
- Quadruped Positions:
In a hands and knees position, just like in plank, your baby will press forwards onto your abdominal wall. For some women this is fine, their Transversus Abdominis can withstand the load. But if you have a separation it is much harder for the abdominal wall to contract against that load. The suitability of a quadruped position will vary from woman to woman. If you feel that the babies weight is pulling your belly to the floor or if you know you have a separation, leave this position out or gently support your belly with cushions underneath you.
- Deep back-bends:
One of the most common postural adaptations is lumbar lordosis, increased lower back curve. This increased curve causes even more length to the abdominal muscles and causes the baby to rest on the abdominal wall and pubic bone instead of the pelvic floor where he/she should. It is important to work on reducing lumbar lordosis as much as possible. So why would we choose exercises which reinforce it? When incorporating spinal extension exercises (back-bends), choose those which extend the thoracic spine instead (upper back) and encourage hip extension also. The deeper you back-bend, the further down your spine the extension will occur so reducing your back-bends depth is an approach. Note that in standing back-bends, the Rectus Abdominis must contract eccentrically (as you lengthen them) and then isometrically to hold your position. So I don't recommend these if you have a separation already.
- Belly Breathing:
This is a wonderful relaxing breath which stimulates our parasympathetic nervous system. However, encouraging the abdominal wall to bulge forward with an abdominal separation will encourage more separation. Two of my clients with Diastasis Recti, one a man and the other a woman with no children had incredibly stiff rib-cages. As their rib-cage was not expanding, their abdominal wall expanded instead to generate an inhale. These are the clients I give "homework" to do. They worked on expanding their ribs rather than their abdomen and gradually they experienced less coning and doming of their abdominal walls in class.
From these examples, we can see the relationship of our breath and our core musculature. Save the belly breath for stressful moments.
Honour your bodies needs during pregnancy. It will tell us what it needs, we just have to listen. Only engage in exercises that are comfortable for you to perform. And when your body sends you a signal that it can’t take it anymore, it’s time to adjust. If something feels great, keep on doing it.
So how do we work our abdominals during pregnancy?
You don't. There is no benefit to a workout which isolates our superficial abdominal muscles during pregnancy. Which is more important to you? Having a visibly toned abdomen while pregnant or having a more powerful core during childbirth and to prevent issues postpartum?
Instead, we want to work on our deeper core muscles. The deep core is like a cylinder with a top and a bottom. The bottom is your pelvic floor and the sides are your transversus abdominis (TA). If these muscles are weak or inhibited, other muscles will learn to compensate and/or our pelvis and lower back will take the strain and/or those muscles themselves will be negatively impacted. By that I mean conditions like Diastasis Recti and Pelvic Organ Proplapse.
Strong pelvic floor muscles are important for all women not just pregnant women. Practice your gentle pelvic floor activation by contracting your pelvic floor muscles as though you are holding in wind or urine, then lifting the pelvic floor up. It is especially important during pregnancy to practice relaxing your pelvic floor. It is possible to create a tight pelvic floor with too much work on contractions. Think "light connection" rather than super squeeze.
Read my full post on the Pelvic Floor: Prepping to Push - The Pelvic Floor in Pregnancy
Your pelvic floor and transversus abdominis are co-contractors and work together. You may feel a light abdominal contraction when activating your pelvic floor. To purposefully engage your Transversus Abdominis, feel that you are gently drawing your lower belly up and in. Don't squeeze too hard or you will use your superficial abdominal muscles.
Properly activating your deeper core muscles will give your lower back support. The TA assists the uterus in pushing the baby down and out during childbirth. As it's muscle fibres cross the linea alba, maintaining a strong TA will help to minimise abdominal separation during pregnancy and help any separation to close postpartum. Maintaining connection to and strength of this muscle is very important.
When you join my new Prenatal Pilates Programme you will gain access to my growing prenatal workout library with videos on how to properly activate your deep core muscles, preparing your pelvic floor for childbirth and so much more!
Take care and enjoy a happy, healthy pregnancy!
I am Emma McAtasney, founder of a boutique Pilates studio in Dundalk, Ireland. BASI trained Pilates instructor, BarreConcept instructor and prenatal and postnatal exercise specialist.
I developed my Belly Only Pregnancy Programme in order to provide a growing library of safe workouts for expecting mums to have access to throughout pregnancy.
I love working with women from all over the world – like yourself – to give you clear, applicable information, support you in truly creating core strength, fall in love with your strong and healthy body and focus on living your best life!
Together, let’s create a lifestyle that gives us health and happiness for a lifetime!