Why do women have a hard time losing their pregnancy weight?
Many women experience a combination of an umbilical hernia and a condition called diastasis rectus abdominis (DR)the unnatural widening between abdominal muscles.
By ABIGAIL KLEIN LEICHMANUpdated: JUNE 17, 2021 12:05A CLIENT uses the online program for postpartum DR. (photo credit: DANI SARUSI PHOTOGRAPHY)
Three years after the birth of her second child, “Rina” still looks a few months pregnant.The reason, quite common in postpartum women, is a combination of an umbilical hernia and a condition called diastasis rectus abdominis (DR), the unnatural widening between the two sides of the rectus abdominis (“six-pack”) muscles straddling the abdomen vertically from the pubic bone to the rib cage.These two sides normally are held taut at the midline by the linea alba connective tissue. The linea alba stretches and thins during pregnancy, as does the whole front wall of the abdomen. DR occurs during all pregnancies but corrects itself soon after childbirth in about two-thirds of women. One in three is left with a sagging belly.DR can also affect men and women who have a lot of abdominal fat or who weight lift while holding their breath – anything that causes sustained intra-abdominal pressure that stretches the abdominal wall. Although not a dangerous condition, DR affects a woman’s self-esteem and can cause pain or difficulty doing simple things like playing with her kids on the floor.Women with chronic DR have been found more likely to develop pelvic floor dysfunction such as urinary stress incontinence (leaking when they laugh, cough or sneeze), constipation or pelvic organ prolapse. Yet it often goes undiagnosed. One local OB/GYN doctor we interviewed said, “Regarding the common sentiment among women about doctors not checking for DR postpartum, this is probably because, at least in Israel, the condition isn’t really part of our training. We are not taught about it in any detail, nor taught how to examine for it or diagnose it.”WORKING WITH a client. (Credit: CINCY KAPLAN)RINA, A 35-year-old Jerusalem resident, was told by her doctor that surgery could help but she was advised to wait until she had completed her family. Meanwhile, the surgeon recommended swimming or Pilates. she’d already been doing Pilates; it was her Pilates instructor who “diagnosed” the DR to begin with.“I didn’t want to have surgery, but I really wanted to fix this,” says Rina. “I didn’t feel strong in my core and it really bothered me looking pregnant even years after I gave birth. It’s annoying and frustrating.”Hoping to have another baby, she adds, “I can’t bear the idea of doing this all over again to my body. I want my body to be strong and to be able to bounce back.”Rina’s online research turned up plenty of guidance on what not to do – classic crunches or other core-strengthening exercises can make the condition worse – and little on how to heal it.Then she bought the book Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation by Katy Bowman.“She strongly believes you can heal DR with proper movement and alignment,” says Rina.The book was a game changer, but she felt the need to get feedback from a professional to guide her, provide more detailed explanations and make sure she was doing the exercises properly.“I was ranting to my husband about this issue, and he said, ‘Well, we need to find someone in Israel to help you.’ He googled in Hebrew and found a video by Rachelle Oseran,” Rina recalls.“He said, ‘She seems to be a national expert in this subject,’ and I remembered that I’d heard about her as a childbirth, fitness and mindfulness instructor. I said, ‘I think she even lives in our neighborhood!’”INDEED, OSERAN is well-known in Jerusalem and beyond as a certified trainer of Lamaze childbirth educators and as a specialist in pre- and postnatal exercise, yoga and Pilates since 1985. A native of Rhodesia (Zimbabwe) who moved to Israel in 1976, Oseran was sensitized to the problem of DR through her studies with the influential maternal-infant health advocate Elizabeth Noble in California. Over the past 36 years, Oseran developed her own approach of body alignment, breathing and muscle activation to help individual clients with DR.“Any woman with a ‘mummy tummy’ after pregnancy will think about this every moment of her waking day. She’s googling and finding misinformation and fear mongering implying that you have to be careful not to make the situation worse. Doctors tell her nothing can be done until after childbearing,” Oseran says.“There’s actually so much that can be done between pregnancies, and it’s never too late to start healing DR and to strengthen your core. Without activating and strengthening the core muscles, the connective tissue will not regenerate and change, and her DR won’t heal.”During the pandemic, she recognized the need to make her method available and affordable online for the masses. Her new Improving Core Function course, launched January 1 at improvingcorefunction.com in English and Hebrew versions, is the culmination of her accumulated experience and research.The three-month progressive strength training program is done at home, with optional live support and peer Facebook groups available. The exercises, with modifications for individual differences, emphasize deep core muscle strengthening to tighten the loose connective tissue.MIRIAM BLOCH, a pelvic floor physiotherapist in Jerusalem for the past 13 years, has seen many DR cases.“It’s often difficult to solve because we’re so sedentary and we expect our bodies to just come back to what they were before childbirth without special attention, and also a change in posture after childbirth can contribute to the problem,” she says.Without commenting directly on Oseran’s method, Bloch says, “Theoretically, a program that teaches how to breathe and then adds load slowly, focusing on posture and spine lengthening, can help. A program that coordinates the work of our core – the diaphragm, abdominals, deep back muscles and pelvic floor – is what we all need.”Oseran has seen success with clients, including one woman whose severe DR was considered a no-brainer for surgery.I have helped hundreds of women avoid surgery and heal their diastasis. In some cases surgery is warranted, but very few,” she says, adding that the frequent companion of DR, umbilical hernia, can only be fixed surgically.Six weeks into Oseran’s three-month program, Rina reports that she’s seeing results.“It’s been really incredible,” she says. “I’ve learned how to activate what Rachelle calls the deep core muscles. Now the fear of doing a movement and making my belly pop out is gone because I’m moving in the right way. I am stronger and feel better when I do things like lifting my child.”Rina also is following Oseran’s advice to walk several times a week in addition to at least four workouts alternating between strength training and “Mindful Movement” workouts outlined in the plan.“Her emphasis on mindfulness has taught me how to let go of the self-judgment about having this issue or my lack of progress. It is improving my life emotionally and psychologically,” she adds.Since she has the advantage of living nearby, Rina has scheduled some one-on-one sessions with Oseran as well.OSERAN SAYS she’s passionate about helping people with DR.“We used to think that multiple gestation, a short body build, a large baby, the amount of weight a woman gained in pregnancy and lack of exercise in pregnancy were risk factors for developing diastasis recti during pregnancy, but research doesn’t support this,” she explains.“What research does show is that 100% of women in their 35th week of pregnancy have diastasis recti. The abdominal wall is designed to stretch for the very purpose of growing a baby. Many women feel guilty for having done something during pregnancy that caused their DR, but this statistic should assuage their guilt.”Her goal, she says, “is for women – and men – to be confident with their movements and to be comfortable in their bodies.” For more information, see improvingcorefunction.com.
