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Postpartum Tummy

Berkeley Parents Network > Advice > Pregnancy & Childbirth > Postpartum Tummy


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Post-Baby Plastic Surgery?

June 2009

After giving birth, I am extremely unhappy with my post-baby body. It has been 18 months and although I work out and eat healthy, my body doesn't satisfy me. I am in my early twenties and feel that my extra tummy pouch gets in the way of my confidence and do not want to live the rest of my life like that. I am wondering if other mom's have had experience with a tummy tuck/ breast reconstruction and have any advice. How much did it cost and is there a doctor that you highly recommend. Thank you. Anon


Hi mom, I also had that problem after having three kids. Nothing seemed to help me get my shape back. I finally went to see Board-Certified Plastic Surgeon Dr. Michael Cedars in Oakland. He was recommended to me by my internist and has been listed many time in San Francisco and Oakland Magazine as the ''Bay Area's Best Plastic Surgeon''. I decided to have an abdominoplasty (Tummy Tuck) along with some liposuction. Dr. Cedars did a great job and I am very pleased. My recovery took two weeks with the first few days being the hardest. Dr. Cedars's staff suggested I get a pain pump inserted during surgery and I think that was very helpful. The most difficult part of recovery was learning how to get out of bed right after the surgery. Everyone on the staff was exceedingly friendly and helpful. Dr. Cedars could not have been more considerate of my modesty and was willing to answer any question I could think of. I am very happy with the results of my Tummy Tuck and would give Five Stars to Dr. Michael G. Cedars!! I'd do it again in an instant!!
you need to wait longer. It took 2 years for my body to slightly resemble my pre baby body.... I am not against body modification in any way shape or form... But you have to remember that unless you get a very good plastic surgeon you could end up with scars and things of that nature... Even if you do get a very good surgeon... Finally happy with my body again
If you are unhappy about the shape of your abdominal wall, you might be dealing with a diastasis (abdominal separation) and/or a functional imbalance in your abdominal muscles.

After pregnancy, if you do a lot of crunch type exercises, without having first strengthened your deepest abdominal muscle, your Transverse Abdominis, (TvA) then your abdomen will bulge outward during periods of exertion. Many women end up ''five months pregnant looking'' due to these issues.

In fitness, what you practice is what you get. Bulging occurs because the TvA is not strong enough to stabilize the abdominal wall against the force of the stronger external layers, the Rectus Abdominis and the External Oblique. This is a very common postpartum problem and the more your try to solve your ab problem with crunches, the worse it gets.

Bulging of the abdomen also stretches the mid line (making diastasis worse) and further prevents the abdomen from re-flattening. I would suggest that you try postpartum corrective exercises before surgery. I have trained many hundreds of postpartum women, and have only seen one case of diastasis severe enough to warrant surgery. If you have a severe diastasis, you should also be evaluated for an umbilical hernia, as this more rare complication can occur.

All post-baby women have looser abdominal skin. While exercise can improve the appearance and reduce the amount of subcutaneous (under the skin) fat, skin texture does not bounce back to its pre-pregnancy condition. Helene


Extra tummy skin

Aug 2006

I had my second baby about 10 months ago. I have lost most of the extra weight, have a flat tummy, but I still have extra skin on my tummy. It looks like an elephant! The extra skin actually hangs over the top of my pants a little bit. Very gross, and sadly, nothing that pilates or any other exercise will fix. Its literally just extra skin! (Didn't have this first time around at all.) I saw this same question in the archives and most people said its caused by a loss or breakdown of the collagen in your skin. Someone recommended Retin A or microdermabrasion. I am wondering if anyone has tried these, or anything else, or found any other way to smooth out extra wrinkles? I am so frustrated by this skin flap! Thanks for your help and advice.


I had the same situation after my first, 9lb , 23inch long son. Lost all the weight, and even ended up 8 lbs less than before pregnancy ( which is a lot for somone 5'3). Tried every kind of special exercise, (helen byrne's post partum class, two years of pilates) my Dr. said short of surgery nothing would make the extra wrinkly hanging flap go away. My stretch marks are also apprently among the worst the Drs have seen, and they also never faded to white, becasue they are so deep ( my son is now 5), ironically I never had one stretch mark until pregnant. I even have to wear one pant size bigger than pre-pregnancy to accomodate my extra flap ( which could hold a pencil in it). The wrinkly skin will get better for a little bit over time,and some creams may help the appearence, but if your skin was stretched to the point where there is a hangling flap..there really is nothing you can do..as you lose weight it will look more and more wrinkly. This is why I get angry with all the work out books saying you *can* get back your old body-I'm sorry but for some women this not true. Only surgey can get rid of what is now extra skin. Over time I learned to accept my flap and wore clothes that hid it, and only a one piece bathing suit. I now have baby number 2, ...and maybe after I am done child bearing I will consider surgery to cut away the extra skin, but having been through two emergency surgeries, I can tell you surgery is no picnic either. I focus on my two beautiful healthy children...my only regret is that I didn't appreciate my pre-pregnancy body as much as I should have. ( No one told me I would endup with an extra body part !) living well with the extra flap
I had the same issue after 2 babies, lots of exta skin, I'm small but gained over 50 pounds with each baby. I tried exercise and all sorts of stuff, nothing took care of the skin so I opted for a tummy tuck. I had pretty severe diastasis recti as well (separation of the abdominal muscles) and surgery was the only option that would address both my muscle separation and the excess skin. I am so pleased with the results, totally flat tummy, muscles realigned, and no more rolls over my jeans when I sit down. My surgeon was Dr. Elizabeth Lee and I recommend her highly, she's had a lot of posts on the parents network so you can look her up if you like. I know it may sound drastic but I have never regretted my decision.

Diastisis Recti - exercise?

June 2006

I have a 1 & 3 year old and just a few months ago noticed I have Diastisis Recti when I lost my pregnancy weight and more but I still looked 4 months pregnant. I am told surgery is the only way to really fix it, but I may want to have a third child, so I am stuck with my tummy for a few more years until I decide. Has anyone had any luck addressing their Diastisis Recti via excercises? My primary care dr. told me just to do situps, but that is exactly what a pilates instructor told me not to do (as well as a book that I bought on it). The book told me to basically do excercises that suck in the tummy but then the pilates instructor told me this was counterproductive. She gave me some excercises that seem like they address the ''corset muscle'' but are so subtle I can't imagine they would actually do anything, and I am feeling like the whole thing is kind of pointless, but I am so self conscious about this tummy! Anyone had success at this late stage?? anon


Greetings. I am a Women's Health physical therapist with a specialty in treating the prenatal and postpartum population. Healing and recovery in the postpartum stage can extend up to 2 years. It sounds like you have gained some information on re-educating your transversus abdominis. The healing process usually involes muscular re-education, soft tisue work, manual therapy and Pilates. Feel free to contact me if you would like more information or would like to schedule a session. Suzanne

Diastasis Recti not improving after 4 years

Feb 2006

I had a pretty serious separation of my stomach muscles down my midline (Diastasis Recti) from my first pregnancy and it got worse after my second pregnancy. I've been trying to do some exercises recommended for the condition (from Elizabeth Noble) but it doesn't seem to be getting any better. Currently, I'd say my muscles are about four finger-widths apart which creates a significant belly and the top of my belly button protrudes pretty severely. I am about 5'2'' and 100 pounds so because I'm so small and my belly is so big, I generally look pregnant (I got asked before getting on a roller coaster- although that was a few months ago and it has gotten a BIT better). Unfortunately I don't have the money to go shopping for a whole new wardrobe and each morning when I get dressed it bothers me... why did I dress in such tight shirts before?!!! :-). I have very few items I can wear that don't make me look pregnant. I know its silly but I do worry when I'm having a beer or glass of wine that people think I'm drinking while pregnant.

Anyway, my doctor suggested that I could have a surgery to repair it, and because it is a structural problem that can lead to back injuries and whatnot, it is covered by insurance. However, I am reluctant to do this because 1) its such a major surgery, 2) I should be sure I'm not having more children since they sew your muscles together and it could tear or have to be cut if my stomach stretches a lot again (my children were 10 and 9 lbs each so I'd expect my stomach will stretch a lot again), and 3) I'm nervous that it might look even worse.

Has anyone else dealt with this problem? Does it get better over time? Did you experience any serious side effects (back problems) from it? Did you have any complications during subsequent pregnancies (I've heard it can get pretty bad)? Has anyone had the surgery? If so, what was your experience?

I waited 4 years between children and the condition didn't seem to get better the first time so I'm not expecting it to now, but I suppose I'm hoping.

Thanks
Tummy Trouble


I had this same problem after my 10 pound son was born. It did get better (less of a gap) eventually, but in the meantime it caused MAJOR problems that I truly believe contributed to my being partly disabled from myofascial pain syndrome, in that it truly impacted my posture to where my body could no longer compensate. I am now paying the price. My advice to you, is figure out when and if you're going to have another and then plan to get the surgery after. Believe me, there could be HUGE problems for you for the rest of your life. No amount of situps, yoga, etc helped me. You need a strong, supportive front to support your posture or else your body has to do all kinds of compensating, every moment you're awake. Elizabeth
Hi there. Sorry, that your abdominals took such a beating. I am a Physical Therapist, and mom of one, so I understand the huge stress that our tummies undergo during pregnancy. First, do not have this done until you are ABSOLUTELY finished having babies. It will undo all of the ''fixing'' and your surgery will have been in vain. Second, when you are totally done with babies, by all means get the best plastic surgeon you can find to do this for you. I work mostly with elderly people, and I can tell you that this will only get much, much worse as you age. And it will present medical problems for you later on, if not back issues, then definitely with your intestines, you can have all sorts of serious, life-threatening troubles with a big gap in your abdominal muscles. Now that your abs are so injured, they are not going to heal on their own. The fact that insurance covers the cost of the surgery should be an indication to you that it's an important surgery (I have found that some insurers fight over even paying for a few weeks of therapy for a person who has had a stroke!) The surgery would absolutely be worth the initial discomfort and recovery time. I know how hard it is to take care of yourself with kids around, but you owe this to yourself.

Until the surgery, try using an abdominal binder during the day. Maybe your Dr. could prescribe one, or you can purchase one at medical supply stores. It is basically a big piece of white elastic fabric with velcro that you can wear under or over your clothes to apply support to your tummy and hold your ''guts'' in. It should feel snug and supportive, but not too tight. Good luck!

PT mama with a little chubby belly


You don't say how many months postpartum you are, but if you are less then six months along, then it means that your connective tissue is still thin from the hormones of pregnancy.

Take care that you do not do any 'crunches' which can make abdominal separation worse. What you need to do is first build strength and control of your deepest abdominal layer, your transverse abdominis. This muscle compresses the abdomen, narrows the waist and flattens the abdominal wall. Compression of the abdomen will act like an internal splint, helping to close abdominal separation from the inside.

There are also various splinting methods, my favorite is with a large exercise band, but you can use your hands too. The most important skill for you to learn is to be able to maintain a flat abdominal profile during exercise.

In fitness, what you practice is what you get. If you allow the abdominals to expand, then that is what you are in effect, training them to do. (Muscle specificity theory.) This is a key postnatal reconditioning concept, especially so with diastasis. If you allow the abs to balloon out during exertion, then you are unintentionally stretching your midline and making the condition worse.

I've been teaching post-pregnancy reconditioning for many years now, and have great success closing the midline with specific exercises. I'd suggest you see what you can achieve with exercise first, before surgery. And yes, you should wait until you are through with having kids before you go down that route.

For more in depth information on abdominal separation and postnatal abdominal reconditioning, consult my web site: www.befitmom.com. Click on Prenatal and Postpartum Fitness and Exercise, then select Abdominal Separation and/or Abdominal Reconditioning after Pregnancy.

Good luck
Helene Byrne, www.befitmom.com


My belly is so big that I look pregnant, but it's hard

Feb 2006

This is somewhat similar to some earlier postings. I have had 2 children a c-section 8 years ago and a vbac 5 years ago. My belly is so big that I look pregnant. But it is not soft it is hard and firm and huge. I have been doing pilates for the past 2 years and this has not changed its size. It is largest at night. I am currently undergoing exams - ultra sound etc. but wonder if anyone else has dealt with this problem. My friends and family are shocked, concerned and puzzles so it is not like I am exagerating. I think in the morning I look 3 months pregnant (2nd time round) and in the evening 6 months pregnant.'' Any advice would be greatly appreiciated.
Big Bellied Mama


It sounds like you have a diastasis--look in the archives for more discussion about this. You need to hold the diastisis closed with your hands while doing abdominal exercises. If you do abdominal exercises (including Pilates) in the standard way while you still have a gap between your abdominal muscles, you will end up bulging more, not less.
Another bulging mother
You probably saw my post about my own belly issues (diasatasis recti) and considering the effort you've put into trying to figure out the problem (ultrasounds, etc.), you've probably already ruled this out. But I just wanted to let you know that it sounds exactly like what is going on with my belly. In the morning, its not that bad, although it ALWAYS pops out, but after a meal or especially in the evenings, it can get huge.

I'm not overweight, in fact, I'm slightly underweight, so it is very easy to see the fluctuations in my stomach. And like yours, my stomach is not jiggly, it is firm, round, and of course, protruding. Friends and family are also concerned (especially cause if I do a stomach crunch the midline of my stomach sucks in like a big trench or peaks like a mountain range) so I believe you when you say you're not exagerating. For my condition, I was told that pilates would make it worse because of the jack knifing type moves and other unsupported stomach muscle exercises. Anyway, just wanted to let you know in case there was a possibility that this (diastasis recti) was happening to you too.
belly issues too


The large, round, hard shape of you belly could have several causes.

First off, you say you've tried Pilates. But can you effectively isolate and contract your transverse abdominis? If you do this correctly, then your waist line will get smaller and your belly will flatten. It's possible that you are unknowingly 'bearing down' during exercise. This will cause the abdominals, especially the lower abs, to expand. As I stated in another response, in fitness, what you practice is what you get. It is not unsual for the abdominals to get hard and bunch out during exercises like 'crunches' especially if your transversus is weak.

Secondly, posture plays a big role in the shape of the abdominal wall. If your pelvis is tipped, (which increases the curve of the lower back) and you habitually drop down/sag into your spine, then this tends to push your guts down and out. This action conbined with functional weakness in the transversus is common after childbirth, and could be a factor.

The third issue is diet. If you have a lot of undigested sugars being dumped into your bowel, this can cause a lot of bloating. Remove all junk food, especially sodas, food colorings and preservatives, sugary foods and those with high fructose corn syrup from your diet for at least three weeks. Eat foods that soften stools, like prunes, and drink a lot of plain water. You want to flush out any bacteria build up that might be giving you a problem. Eat yogurt with active cultures to re-estaablish a healthy colony of the ''good guys.'

For more information on how to strengthen your transverse abdominis, consult my web site: www.befitmom.com. Click on Prenatal and Postpartum Fitness and Exercise. Select Strength Training and Core Conditioning, and look for the exercise ''Transverse Abdominis Isolations against a Wall''.

Best of luck. Helene Byrne


I just received a mass email reminding one to be more aware of ovarian cancer and the symptoms. ''Pelvic and/or abdominal swelling, bloating and/or feeling of fullness'' was one... For a full list and more info, here's one link: http://www.ovarian.org/pages.asp?page=symptoms Helps to at least RULE OUT all the scary things.
Always Aware

Losing the belly with exercise

Jan 2006

I have been doing aerobics and eating properly and got back to size 8.However, while I seem to be losing weight from all over the body, my belly remains. Is it something to do with pregancy and how it alters the female body? Is there any one out there who thought it is not possible to get rid of the tummy but did so anyways? Please let me know which exercise tapes you used, any special tips etc. I really would not consider some thing like liposuction, but I wonder whether that is the only solution....


Stott pilates has some good pilates videos you might want to check out, but probably the best thing is to take a pilates class, where someone can watch you and correct you, etc. i teach pilates and i find that often people don't do stuff right from the videos. there are several teachers at the studio (we are in Montclair on Medau at Moraga) who are great with postpartum exercise (have had kids themselves and such). if you want to do stuff on your own you can never go wrong with pelvic floor exercises. Another good thing is to think navel to spine while you do your ab exercises so that you are not puffing your belly out while exercise-helps work the deeper abdominals so you don't make your ab muscles bigger.
pilates teacher with 2 little ones
Flabby belly? I've got one word for you: Pilates! It's amazing and it works and it's cheaper and less invasive than surgery. Your genetics will play a significant role in all this as well, but Pilates will help a lot. Good luck! anon
Aerobic exercise is great for burning fat as fuel and helps new moms return to their prepregnancy weights. But if you want to flatten your tummy after pregnancy, you need to do the right exercises, and rebuild all four layers of the abdominal wall from the inside out. If you start with exercises like ''crunches'' which work the outer layers, then your abs will bulge out upon exertion- exactly what you don't want to happen. In fitness, what you practice is what you get- muscle specificity theory. So if you unintentionally allow you abs to balloon out, that is what you are in fact training them to do. Woops. You can find out how to rebuild your body after pregnancy the right way with my book, ''Exercise After Pregnancy: How to Look and Feel Your Best''. You can read the first few chapters on my current web site to see if is something that will work for you at: www.exerciseafterpregnancy.com. FYI, in a few weeks I'm launching a new web site: befitmom.com, that will provide free in-depth information on all aspects of prenatal and postpartum fitness and exercise. Look for the debut in the Announcements newsletter.
Helene Byrne author, ''Exercise After Pregnancy: How to Look and Feel Your Best''
Try working your obliques, if you haven't already. Also remember that Kegel/pelvic floor exercises are really a part of the deep lower abs... Congratulations on the work you've done! you can do this, too. Bonnie

Safe exercises for diastasis recti

June 2004

I have diastasis recti (separation of the abdominal muscles), about 3 finger-widths at the widest part around my navel. This manifested itself after the cesarean birth of my daughter three years ago. Unfortunately, I never managed to take a postpartum exercise class, and now, 3 years later, I wonder if it's too late to do anything about it. I know that there are exercises that I should NOT be doing, but what exercises are safe and beneficial for me to do with this condition? Is it too late to lessen the separation? Are there any implications for future pregnancies (we would like to try for a second soon)? Suggestions for good books, or trainers/specialists who can show me what I should and should not be doing would be greatly appreciated.
Better late than never?


There are exercises that you can do to improve the alignment of your abdominal wall even after three years. I am a physical therapist who also teaches a prenatal exercise class in Oakland and we focus quite a bit on the transverse abdominus muscle, pelvic floor and avoiding overstraining the rectus muscle. I recommend that you get your abs in better shape before getting pregnant again. It will spare your back the added stress. To see me one on one at the clinic you will need a doctors referral for PT. You are welcome to join my prenatal execise class when expecting if you want further instruction. Otherwise Helene Bryne runs a post partum class that also addresses your issues. If you call her she can give you further details. It is possible to tighten the abdominal wall at any time. Genetics also plays a strong role!!
Diastasis recti, or abdominal separation, is only problematic during the postpartum period when your connective tissues are still lax from the hormones of pregnancy. It resolves anywhere from 3 to 6 months after childbirth. And no, at this point you can not do anything to bring the two sides of your recti muscles closer together. But it isn't a problem at this point either, and does not effect the functioning or limit the strength potential of your abdominal wall. If you stomach is still bulging out, that is not casued by abdominal separation, but rather by weakness in the deepest layer of your abs, the transverse abdominus. There are many exercises that you can do to work this muscle. Contrary to what many assume, crunches work the exterior muscles, and do not flatten the abs. For exercises that flatten the abs, check out my book, '' Exercise After Pregnancy: How to Look and Feel Your Best'', www.exerciseafterpregnancy.com. As to your next pregnancy, your abs probably will separate again. But here again, doing exercises which focus on the transversus will help a lot to keep your mid line together, and will help your abs bounce back that much faster after childbirth. Helene Byrne
I don't think it's too late to close your diastasis recti. I don't know of any physical therapists in the East Bay, so I can't specifically recommend anyone. I am a physical therapist and had to close my own diastasis recti after my pregnancy.

Exercises you SHOULDN'T do with a diastasis: Don't do the traditional situp, where you're lying on your back and doing a crunch. Also don't do exercises where you are lying on your back with your legs up and raising or lowering them both off the ground. Those types of exercise may cause further damage to the rectus abdominis muscles.

Corrective exercises for diastasis recti: There are several exercises to correct a diastasis. I am going to describe the least strenuous one and the one you should start with. You should continue with this exercise until you are closed to at least 2 finger-widths. I used this as my only exercise and was able to close my diastasis from about 1 1/2-2 finger-widths to half a finger-width.

Lie on your back with your knees bent and feet flat on the floor. Cross your hands over your abdomen to help support the area. As you EXHALE, lift ONLY your head off the floor while you use your hands to gently pull the rectus muscles toward midline. If you see a bulge when you lift your head up, lift your head until the point just before the bulge appears. Then lower your head and relax.

I would recommend placing your hands below the level of your belly button, at the level of your belly button, and above the level, just to be sure you are closing the entire length of the diastasis.

It's a pretty mellow exercise and shouldn't cause any pain. Hope that helps


Postpartum saggy belly

Jan 2004

I need some advice about what to do/expect with my postpartum wrinkly tummy. I gained 60 pounds with my last pregnancy, and I was totally HUGE compared to my usual very skinny self. My stomach skin got so stretched it was incredibly painful. I'm 6 months postpartum and have lost all but 4 or 5 pounds and my stomach is pretty flat, but I'm left with wrinkly, loose skin just around my navel. I think the reason this is bothering me is that I remember my mother having the same thing when I was a kid, and I always thought it looked yucky. Now I have it! Is there anything to do about this? My mom never exercised a day in her life, so I'd like to think that's why she didn't lose hers. I used to be in great shape before babies, so maybe there's hope? I'm not usually this vain, but I think I'm needing to distinguish my tummy from my mom's!


yes, i have the 90 year old lady's chin on my belly too. i actually have lost more weight than my pre-pregnant self and had to buy new clothes to accommodate the weight loss (now a size 2!). but alas, my belly is wrinkly and squishy. my baby loves to tug on it while breastfeeding, which is the only time i think it's cute!

anyhow, i showed a friend and she asked her obgyn relative/friends and they said it's all genetic. you can exercise to get it flat again, but the extra skin will not go away if it's in your family. i've seen some mommy's w/ great tummy's afterwards, but me, i have the jiggles! not the jelly beyonce was talking about


Wrinked skin after pregnancy is very common, especially if you carried big, have had several babies, or multiples. The collegen fibers in your skin (which creates elasticity) becomes overly stretched out. Unfortunately exercise does not correct the condition. Neither do any of the creams that you see advertised. There is some evidence that Retin-A compounds stimulate the skin to build more collegen. But of course, you can't use it while breatfeeding. Also, some of the cool light laser resurfacing techniques like microdermabrasion, also stimulate the production of collegen. These require multiple sessions, and cost big bucks. Another option is to wait until you are sure that you will not have anymore babies, and get the excess skin removed. Also big bucks. Lastly, you can do what most of us do: switch to a one piece bathing suit and try to age gracefully. More info on bouncing back after pregnancy can be found at my web site: www.exerciseafterpregnancy.com Helene Byrne
I'm a certified Pilates instuctor and I highly recommend trying it. It is an amazing form of exercise and it can do wonders for the core- abdominal area. I've been teaching Pilates for almost ten years and I'm also a Mom of a 7month old. If your interested I have a home studio on N.Berkeley. I have all the apparatus and have flexible times. Skye (510)883-0124 Skye
Also recommended by 2 people: Tummy Tuck
I have a friend who has had 2 boys (now 6 and 8). She's TINY, is in amazing physical shape, and has a wrinkly tummy. She has been told by doctors that she has great tummy muscle tone, but that has nothing to do with stretched out skin. It can be remedied with a tummy tuck operation, but that's too extreme for her so she just lives with it.
October 2003

hi everyone, as i prepare to celebrate my baby's first birthday(!) i'm boo hooing my saggy belly!

i know in previous conversations people have said wait 9 or more months and it'll snap back etc. and that time has passed. i do moderate exercizing and am below my pre-preg weight. if anything, my tummy is flatter than ever, but it has a bunch of saggy skin! i gained around 50 lbs during pregnancy...

anyhow, is there anything that can be done about this that doesn't require a scalpal (which is not an option!)? it's ok when i stand up, but when i sit down it looks like i have the belly of a ninety year old lady - or her saggy chin is more like it. i exfoliate and that helped get rid of most stretch marks, it's just the extra skin that's bugging me...

if this is just the way it is, then i can find some closure - i just need confirmation i guess~! at least my baby likes to tug and pinch it, so someone is enjoying it! miracle cures welcome


For a saggy belly, I highly recommend doing Pilates. It has helped me tremedously. I have a fabulous instructor, Skye. She has a home studio in North Berkeley with all the equipment and is so knowledgable. She is a mother of a newborn too so she has great compassion for the saggy belly. Skye's can be reached at (510)883-0124. Try it, it helped me. Anon
Julie- It sounds like you have a diastasis recti, a separation of the rectus abdominus, the central abdominal muscle that the body builders call "the six pack". It is very common and happens sometimes during pregnancy. As the belly grows and expands more pressure is put on the central tendon and sometimes the muscle separates from the tendon. It can also occur during the pushing phase of labor if a woman holds her breath when pushing. The separation becomes a concern when you can fit 2 or more fingers in the separation. Because it involves the rectus abdominus muscle, I strongly recommend against doing regular sit-ups, curl- ups, rotational exercises involving the abdominal region, leg lifts, laying on your elbows with a towel under the toes and pulling your legs underneath you or "jack-knifing out of bed" as these maneuvers put more strain on the rectus, which is what you want to avoid. When the separation is less than 2 fingers you can start doing more aggressive exercises, but for woman with a diastasis recti greater than 2 finger breath separation I would recommend a gentle progressive program starting with Kegals, and working the deep abdominal muscle, the transverse abdominus. This will help with improving your stability and conditioning the abdominals. You can progress to pelvic tilts with transverse abdominus contractions and later to curl ups with approximation of the separation (by laying on a towel and grabbing the right end with your left hand, the left end of the towel with your right hand pulling the towel across your body to hold in the separation). I would also strongly recommend a couple of sessions with a professional who works with pregnant and post-partem women: a Physical Therapist, Exercise Physiologist, or trainer. That way you can get the proper feedback on isolating the appropriate muscles and not overdoing it. It is difficult after having a baby, to have a good sense of where your abdominals are and how to correctly isolate and fire the ones you want. This is a something that the average therapist/exercise physiologist/trainer may not be familiar with, so ask about their experience/training working with diastasis recti. Best of luck, and patience. Kelli Manring, PT, MSPT Physical Therapist

Abdominal muscle separation postpartum

October 2003

At my 1 month postpartum doc appointment my OB told me that my abdominal muscles had separated (about 3 fingers width) and that it was possible that they would not repair. Does anyone know how common this is so long after delivery? Does anyone have any advice about how to repair this separation by exercise or surgery? Would living with this mean living with my currently distressing pot belly? Thanks! Julie


Can all go back to normal. It's very common, actually. I certainly had that, too, but it was gone at my 8 weeks check-up. What to do? Pull-ups, expecially right-elbow to left knee and other way round. ''After the baby's birth'' by Robin Lim has more suggestions, also exercises you can do with your baby. Postpartum Yoga - check out Yogalayam on 1717/23 Alcatraz, Tu 10-12 and Th 2-4, phone (510) 655 3664. The teacher, Saraswati, has an enormous experience with everything around pregnancy and childbirth. Walking - with your baby in a sling or in a stroller - is also very helpful, and very easy to realize.
All the best
Julia
Dear Julie:

At one month postpartum, it is very early to be worrying that the shape of your postpartum belly is permanent. It is really true that your belly developed the big ripe shape of a term pregnancy over 9 months, and you should wait at least that long for nature to take its course and pull you back into shape before deciding that your 'pot belly' will never go away.

That having been said, the separation of your muscles is called rectus diastasis, and is often permanent. The muscles themselves shorten over time from their stretched position during pregnancy, but the connective tissue between them, called fascia, does not have the same elasticity that muscles have, so once stretched, it will never return to its pre pregnancy size. However, if your skin is in good shape, your little 'pot belly' will get better than it is now, and you have a good chance of regaining that flatter shape that you miss. But you have had a baby, and if you wore tight jeans before the pregnancy, you might not get back into them, because your body has changed.

My advice as a plastic surgeon is just wait awhile. In 9 months, if you still don't like what you see, you can be evaluated for a tummy tuck procedure which tightens up that stretched fascia and removes extra skin in your lower abdomen. Until then, enjoy your baby, do your aerobic exercise as you have time, make sure you have at least one outfit that fits you now that you feel good in so you are not always aware of your 'pot belly' and relax. Your body is likely to continue to get better on its own. elizabeth lee, m.d.


Re: Abdominal Separation, as a perinatal exercise specialist, I have to weigh in on this one.

I didn't see the original post, but I can tell you that a separation of two finger widths is normal at six weeks postpartum. And that the shape of your belly is NOT related to abdomianl separation. You've got two separate issues here.

To flatten the abs after pregnancy, you need to start with the most interior layer of the abdominal wall, the transverse abdominus. This is your internal ''girdle'' muscle. By building strength in this muscle first, when you do get to crunches and such, the abdominal wall will remain flat upon exertion. This is a very important concept of postpartum conditioning. In fitness, what you pratice is what you get. And if you do crunches without the underlying internal support you belly will definately bulge. Bulging of the abdominal wall actually increases abdominal separation. (I've also found that most women to not perform the abdominal separation test correctly.)

One respondent seemed to suggest that you do oblique crunches. I do not recommend this. Oblique work can place shear forces across the abdominal wall, worsening abdominal separation, especially if the transverse abdominus is not strong enough. Generally, many types of traditional crunches are contraindicated for those with abdominal separation.

It is also important to note that abdominal separation is only a problem in the first months after pregnancy. Yes, the rectus abdominus does not go back to it's original position, but once your connective tissues have tightned up, (anywhere from three to six months post-pregnancy) you won't have a hole there anymore, and you will not be at risk for herniation. It is a myth that you can't have flat, strong abs after abdominal separation.

I'd also suggest that you do not consider surgery until you are sure that you do not want any more children.

For exercises that strenghten the transverse abdominus, and flatten the abs postpartum, check out my book, ''Exercise After Pregnancy: How to Look and Feel Your Best''. It's available locally at many of the babystores and independent bookstores as well as on my web site: www.exerciseafterpregnancy.com Helene Byrne


Abdominal separation after pregnancy is not uncommon. I had a separation as well (which has since come together). The good news is that are are exercises that you can do to encourage the muscles to come back together. You want to first focus on strengthening the pelvic floor, through exercises like pelvic tilts and kegels. You also want to do gentle abdominal exercises like belly breathing. I demonstrate these exercises in my ''Postnatal Exercise for Mom & Baby Video'', or if you aren't a video person, I recommend Helene Byrne's book and classes. I'll put links to how to get info on both of these at the end of this post.

Equally important, there are exercises/movements that you should avoid so as to not make the separation larger. Avoid advanced abdominal exercises (such as reverse curls, crunches, cross-over external oblique exercises, etc) until the muscles have closed and the pelvic floor is strong. You will also want to use splinting techniques during exercises most abdominal exercises.

For some women the separation closes on its own natually within a few months, but you can encourage the closure and take steps to keep it from getting larger.

You can get my video information and a list of ''Do's and Don'ts for Postnatal Exercise'' at: www.freyafitness.com.

You can get info on Helene's classes and book at my prenatal/postnatal exercise class website related links section: www.marieandron.com/prenatalfitness/htmdir2002/RelatedLinks.htm

Best wishes! Marie


Yes, there are things you can do for postpartum abdominal separation. This condition is called diastis recti and is a problem of not only postpartum women, but also of the obese. I have also seen it on men who have had surjuries that required cutting down the center of the stomach This separation can be felt in all of us, but is normally only about a finger wide. In diastis rectis that separation becomes wider, such as the 3 fingers wide you mention and is basically from the strain of all that added weight and volume. I am sure you have been told to do lots of abdominals- which is sort of true, but can also worsen your problem if not done properly in regards to this condition. In otherwise you need to modify all ab work, so that you are engaging the transversus and are also ASSISTED. The last thing in the world you want to be doing is forcing your way up in a crunch with your belly bulging out of this separation- looks a bit like a long sausage on your belly! For example use a therabands to assist yourself up and only go as far up as you can keep your belly knit together. There are a lot of exercises you can do that should be helpful but all this said there is no guarantee that your separation will mend.

I am glad to give more info on this- I am a pilates teacher and have worked under physical therapists. i would recommend that you work on this problem with a pilates teacher who is understands this issue-(many are not very knowlegeable at all)- also I would work one on one -not in a group class. I would also recommend Sara Swathidevi's postpartum yoga classes at yogalayam-she is a very knowleageable woman. I am glad to answer any questions you might have and you are welcome to contact me or check out my website www.optimumpilates.com good luck andrea


Mama belly: Any advice before I call the plastic surgeon?

July 2003

I have hesitated to post this because I keep thinking the problem will take care of itself, but somehow it never does! I'm in my late 30s. After giving birth to my third and last child 7 months ago, my belly sticks out so much I think I still look pregnant. I obsess that I have a tumor, but I don't. I have mama belly. I don't want mama belly. Or at least not to this extent. I have lost my pregnancy weight and could probably still lose another 10-15 lbs, but the excess weight seems disproportionately attached to my lower abdomen. I work out, I do crunches, I wear ''foundation'' garments. Nothing seems to work. I wonder if I'm doing the excercises incorrectly. I wonder if 7 months post partum is just not long enough. I wonder if anyone has any advice for me before I call a plastic surgeon. Specific exercise recommendations & personal testimonies most welcome. kangaroo mama


Yes, 7 months post-partum is too soon! Although you will probably always have a gentle bulge in the tummy, no matter how much weight you lose, it should go down a lot by about one year after birth. For most women it takes about a year to get back to pre-pregnancy condition. (The old saying is, it takes 9 months to get that way, and it takes 9 months to get back.) And it does get a little worse with every child. Think of it as a badge of honor!
Based on a similar discussion a couple of months ago and my own ''mama belly'' issues, I started doing Pilates mat exercises. I still have more work to do, but am starting to feel pulled together again. As I understand it, Pilates works your deepest abdominal/trunk muscles, whereas crunches work the outermost muscles. You might want to check out the Stott videos sold on Amazon, get a personal session to get you started, or go to a class. Another mama belly
I'm in my late 30's and I've only had one baby but my body just didn't go back to a normal shape until the baby was 12 months old. I ate right and exercised and still it didn't start to really look better for 12 months and then it rapidly improved. Danielle
I highly recommend taking a class through Karen Casino in Berkeley. She helped me ''reclaim'' my abs after a baby. Sorry I don't have her number - I'll bet she's listed. Give her a call. Her classes are held in a studio behind her house. Can't wait to see the other suggestions posted! good luck
What you are experiencing is actually very common for third child/late thirties combination. What you need to do to flatten your abs is to rebuild your abdominal wall from the inside out. That means toning up your transverse abdominus (the waist cincher muscle) first. This muscle compresses and flattens the abdominal wall. Then you need to work on strenghthening the lower half of your abs, i.e. below the belly button. Classic crunches and obliques work the upper half only. And it is possible that your abs are bulging out upon exertion, so that crunches might be actually making your situation worse. For more specifics you can check out my book, ''Exercise After Pregnancy How to Look and Feel Your Best'' at www.exerciseafterpregnancy.com Helene Byrne
The bad news is that having children can make your belly permanently more protruding. The good news is that, at just seven months after giving birth, you shouldn't give up hope yet. It can take a year or longer to get back to (more or less) your pre-pregnancy shape.

One issue you may be suffering from is diastasis recti. During pregnancy, the abdominal muscles can separate in the middle. Usually they spontaneously move back together after birth, but sometimes they don't. You can check if you have this issue by doing a crunch and probing the middle of your abdomen--if you feel a trench that you can stick your fingers into, that's a diastasis. If you have this condition, you shouldn't do regular crunches--instead, cross your arms over your abdomen and use your hands to push the two sides together when doing crunches.

I have this condition and it's improved somewhat but my doctor said I will always look a little bit pregnant (even though I weigh less than I did before getting pregnant). Bulging a bit


Too much tummy skin

January 2003

Hi, I have an 11-month old, my second. I'm 39, and not bouncing back in quite the same way as I did with my first: the weight is coming off a little slower and so on. But I am bouncing back.

However, this time around I did get stretch marks; not a lot, but some. They don't bother me much (I can't see them most of the time). The thing that IS bothering me is the extra skin from my super-big pregnant tummy.

This child was (as is often the case) bigger, and my tummy was bigger. Plus, I was 5 years older. But should that really account for all these folds and folds of loose, empty skin that still lie around my waist? When I ask people about it they treat it like a weight question, answering with diet and exercise; but there isn't much fat to speak of in most of these loose areas.

Any experience/advice in getting your body to reabsorb the excess? Or am I just being impatient? anonymous


Alas, for me the extra skin has continued to hang off of my stomach like a wrinkled purse, nearly three years after my last child. I am at my pre-pregnancy weight and my stomach is more toned than ever, but the skin remains. I've heard that it has more to with how elastic your skin is (how much collegen it has). I also have lots of stretch marks too. Aside from plastic surgery I am under the impression that there's not much I can do about it, except use this as an opportunity to focus on the important things in life -- which are not my looks. (And besides my husband can't see anything without his glasses -- which he removes during more intimate moments.) anon
I'm going to stick my neck out on this one: try brushing your skin! I have brushed my skin with a stiff, natural bristle brush in a certain sequence to improve circulation, soften the skin and tighten loose skin and it works for me . . . to find out about this, go to this online link: http://www.t-tapp.com/home/ and select ''Cellulite Control.'' The exercise program is also very effective. --Becky
I used to feel sad that I was stuck with all that extra tummy skin too until a client of mine showed me how tight her skin was pulled after a double mastectomy for breast cancer. Maybe some day all that extra stuff will come into use somewhere else on my body for an emergency. Right now it's just in storage on the tummy. a new way of looking
I'm sorry to say that there's not really any way to improve the tummy skin, other than surgery, which is obviously a big undertaking and probably not worth it since it would leave scars. Anyone who offers solutions based on diet, excercise, vitamin supplements, etc, should be ignored. But don't give up yet--11 months postpartum may seem like a long time to you, but you probably will continue to see some improvement.

Another thing to try is the modern equivalent of a girdle--essentially, bike shorts that you wear under clothes. Not only will your tummy look flatter; it might even help with the excess skin. After surgery such as liposuction, surgeons recommend wearing support garments to help the skin shrink down. It's worth a try.

Also, I bet that the excess skin is more noticeable to you than to anyone else. People around you probably think you look fine. Anonymous


Postpartum Abdominal Exercises

April 2003

Do you have advice for abdominal exercises I can do at home? I am 4 months postpartum and ready to work on getting my body back. (For the record, I'm eating healthy and happily breastfeeding my sweet baby.) I'm about 10 pounds over my pre- pregnancy weight - and my tummy is so loosy-goosy. If you have any advice for types of exercises that focus on the abdomen (crunches, no crunches, weights, etc.), I would greatly appreciate it. Thanks!


I am a physical therapist that deals with abdominal muscle tone issues in new moms quite often. I think that your best bet would be some guidance in a program that includes the transverse abdominus, pelvic floor and oblique muscle contractions. I had a baby 22 months ago and found that it took me about 6 months before i felt that i could really contract those important muscle groups effectively. You should also consider the low back muscles working together with your abs especially during all of the baby care activities ( car seat, crib etc..) I would be happy to discuss these issues with you in more detail if you are interested. We can also set up some one to one sessions to get you started. There is also a post partum exercise class that Helene teaches in Montclair, she also goes over some of these principles in a class setting. Dawn Loretz
i HIHGLY recommend starting pilates--the emphasis in pilates is on abdominal or ''core'' msucel control, and it gave me back the tummy i had before pregnancy much more quicky than ab crunches (with or without aerobics) did! if you need to work out at home, try the moira stott pilates collection (available at amazon, i'm pretty sure)--she's a very good video instructor-- but it's also good to take a series of classes or do some drop- in sessions to get instyructor feedback. Good luck and have fun! Jessica
I teach pilates and would be glad to give you lots of abdominal exercises to help you regain your pre pregnancy belly. As well as abdominals you will want to do some pelvic floor exercises to strengthen the whole area. I would be glad to talk to you. You can reach me at 510-508-1408. I have been teaching for several years in Oakland and have worked under several physical therapists. andrea (evadne at lmi.net)
Check out my book, ''Exercise After Pregnancy: How to Look and Feel Your Best''. It features a three-step reconditioning program for new moms that can be done at home, without specialized equipment. It will tell you everything you need to know about how to safely and effectively bounce back from pregnancy and childbirth. The first couple of chapters can be read on my web site, www.exerciseafterpregnancy.com. The book is available at local independent bookstores, baby stores, and selected Barnes and Nobles and Borders, and of course Amazon. Helene Byrne
Two ideas for you. 1) There are several postnatal exercise classes in the area that you can bring your baby along with you. I personally teach one in Hercules(see: www.marieandron.com/prenatalfitness), but if Hercules isn't good for you, check out the following link on my website to find other instructors in the area (Berkeley, Oakland, Haward, San Franisco, etc): www.marieandron.com/prenatalfitness/htmdir2002/RelatedLinks.htm 2) If you prefer to workout at home, then check out my ''Postnatal Exercise for Mom & Baby'' video. The video includes a full body workout, including both cardio and strength training/toning. The baby is included throughout, so you can get back into shape and provide a fun activity for your baby at the same time. The abdominal exercises shown in the exercise video are specifically designed for postnatal women -- starting with pelvic floor and gentle abdominal exercises that are needed to start the recovery process for those overly stretched muscles. The video then shows some more challenging abdominal exercises, with modifications to use if you happen to have abdominal separation (how to test for this is also shown in the video). The video comes in both VHS and DVD formats. You can get more information on that at: www.freyafitness.com Best wishes! Marie

Stomach Exercise after C-section

September 2003

HELP! How long does it take for the stomach muscles to recover after a c-section? I delivered a nearly 11 pound baby in April, and my doctor told me it takes about 6 months for the muscles to knit back together so they can flatten out again. What are other people's experiences with this? Is that accurate? After my first baby, regular delivery, I was into most of my clothes before two months passed, but now I have this paunch in my lower abdomen that is preventing me from getting into anything. I started exercising to try to flatten them out, but can still really feel those muscles at 5 months post. I have no experience w/surgery, so my expectations may be off, but it is frustrating to see all my friends who had regular deliveries shrinking right back into their clothes. Anyone else have this problem and not have to shop for a whole new wardrobe???


I had a vaginal delivery 3 years ago and am still trying to get rid of the paunch. I hate to say it, but I don't think it's ever going to go away. I even saw a plastic surgeon about a tummy tuck since nothing else seems to work. I run 5 miles a day almost every day, but have given up on sit ups because it just isn't working. Hopefully somebody has some advice because I need help, too! Anon
After your stitches have healed with a ''C'' your abdominal muscles can be reconditioned in the same way as if you had a vaginal delivery.

Since your abs are still pooching out, I would suspect that you are either doing the wrong types of exercises (crunches flex the upper spine, do not flatten the abs, and are not effective when reconditioning after pregnancy), and/or that your abs are ballooning out upon exertion, a common post pregnancy reconditioning problem.

After pregnancy, women need to rebuild the abdominal wall from the inside out, starting with the deepest layer, the transverse abdominus: your internal girdling muscle. This is the muscle the flattens the abdominal wall. Weakness in the transversus causes the belly to hang out when lax, and will lead to ballooning out upon exertion, i.e. during crunch type exercises. In fitness, what you practice is what you get. And the last thing a post-pregnancy body needs is abdominal expansion. Weakness in the transversus is also highly associated with many common spine and lower back problems.

I've worked with hundreds of postpartum women, and I can tell you that it is a very slim minority that are back into their old jeans before before their babies are crawling. I recommend buying some inexpensive transitional clothes, with elasticized waists, so that you have something that fits your new ''mommy body''. To find out more about reconditioning after pregnancy, you can read the first two chapters of my book, ''Exercise After Pregnancy: How to Look and Feel Your Best'' on my web site, www.exerciseafterpregnancy.com
Helene Byrne, perinatal exercise specialist and author


I had a c-section, and your experience sounds about right to me. A c-section is major surgery, so it takes the stomach muscles a very long time to recover. I had significant pain for many months, as well as that annoying numbness. My girl is now 13 months, and the area immediately around my incision is still faintly numb, though it doesn't hurt anymore. As for my clothes, I bought one pair of post-partum pants and wore them constantly (as well as sweats). Yes, it was irritating, but it was impossible to rush the weight loss so I didn't fight it. Then gradually (VERY gradually) I was able to wear my biggest pants, then smaller ones, etc. Breastfeeding helped take off the pounds, and now I'm wearing all my pre-baby clothes again. As far as exercise, I did NOTHING abdominal for a very long time. It just hurt too much. If you want to exercise you should go easy on yourself. As far as flab goes, I do have a little bit left. I've found that swimming helps a lot, or maybe it just burns calories (in any case, it feels great). hope this has helped you. brie
Oh do I know what you are talking about. I had a baby in April (but 2002!.) She was 10.2 pounds. After my first was born (weighing 7.3 lbs), i easily went back into old clothes and never thought about exercise. I really hate to say this, but even these 17 months later, i still can't fit into my old clothes and it is very hard. I am trying to exercise more now because i have back problems due to weak stomache muscles. Don't give up, and when you can, try and excerise. I hope this is somewhat helpful and not too depressing. Andrea
Don't go shopping for a whole new wardrobe just yet. From a physical therapy perspective it takes a good 6-8 weeks before strength changes occur. During your pregnancy your muscles were overstretched there return to prior state may be dependant on a number of things, time since your first child was born, what exercises you are doing, and yes age. Sometimes when a muscle is cut it can loose its sense of how to work. That's when specific training is needed. If you are not doing any specific training for the deep abdominal muscle, the transverse abdominus, that's the first step. Most people have a hard time isolating this muscle. They work hard at the top layer of muscles, the rectus abdominus, as thats the one most of us can see & feel. Pilates breath work, pelvic tilts--done properly, and hands & knees positions work best to isolate this muscle. Working on the abdominal obliques will help to trim the waistline as well. The physioball/birth ball is fun and also is great training for the abdominals. Patience and persistance, daily but not to over do it (ie. crunches until you cramp...that's way beyond). Look in to a post partem exercise class the instuctor should be able to point you in the right direction. Hope this has been helpful, feel free to contact me if you have any further questions. Kelli Murphy, PT, MSPT kellimurph at earthlink.net
I found the book ''from baby to bikini'' very useful. Also, it took ages for me to figure out which muscles weren't working after my c-section so that I could try to use them again, just in standing and sitting. Side stretches helped, surprisingly, and also lying down (well after the c-section) and pulling the part above my belly button down to the floor. I had been doing situps etc for ages which helped but this last exercise turned out to be crucial, I'd forgotten that muscle was there and hadn't been using it since pregnancy. anonymous
Pilates is a great way to try to get you abs back after a C-section. At our pilates studio we have worked with many women who have gone through a cesareans and it is possible to get your tummy back (though it can be a longer process if you are among those who have decreased sensation or numbness in the area). Generally, making sure that you are working the deep abs, the transversus abdominum, and not the top layer of stomach exercise is the key to getting your tummy flat. Pilates breath work and pelvic tilts are very helpful as well as visualizations, especially if you are one of those with decreased sensation. What you want to avoid is lots of crunches in which you only work the top muscle area. I would be glad to discuss it with you and if you are welcome to get more info about my studio from my website www.optimumpilates.com andrea
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