Wednesday, August 22, 2007

Mummy Tummy, by Lisa Boward

Pregnancy, birth, and motherhood can be some of the most empowering and transformative experiences in a woman’s life, and can give her a whole new respect for the power of her body. Pregnancy affects every system in the body – the hormones produced during a normal pregnancy affect muscles, joints, ligaments, and organs. This does not mean a woman needs to “slow down” or “take it easy” during pregnancy, only to be mindful of the affects that pregnancy has on her body - particularly her abdominal muscles. The abdominals become softer and more lax in order to accommodate her growing baby, and can therefore become separated. Some separation is normal, and is in fact the body’s defensive mechanism to accommodate the growing size of the belly. Indeed, if these muscles became over-stretched, it may make it impossible for a woman to regain abdominal strength post partum.

Sometimes, however, a severe separation may occur. A severe separation, called diastasis, or diastasis recti, is medically defined as a separation between the left and right sides of the rectus abdominis (the muscle covering the front surface of the abdomen from the breast bone to the pubis) and is generally at least two fingers wide. For many new mothers, this “mummy tummy” can cause poor posture including kyphosis (a hunching in the upper back) and lumbar lordosis (an exaggerated curve in the lower back), back pain, a protruding low belly, and can sometimes lead to hernia.

It is commonly held among the medical community that little can be done to prevent, or to recover from a diastasis recti. Many doctors will tell their patients that a diastasis will either heal on its own with time, or it won’t – at which point surgical correction is suggested. Those medical professionals who believe non-surgical correction is possible may offer vague advice encouraging “abdominal exercises” which can, in fact, exacerbate the problem if practiced incorrectly.

The separation is caused by a combination of hormonal changes which encourage a relaxation of soft muscle tissue and the stretching and pressure caused by the growing uterus during pregnancy. Women with weak abdominal muscles are at increased risk, as are those with strong, tight abdominals (think ‘six pack abs’) which have less ability to stretch and can therefore be forced apart as the belly expands during pregnancy.

The first thing to be aware of is how movements performed all day long can have an impact on a pregnant woman’s abdominal muscles. Simple things like the way a woman gets in and out of bed or a chair, and how she lifts things can often cause diastasis. “Kicking up” to seated from a reclined position, or pushing up to standing when seated can be detrimental, as these actions usually cause a woman to push her belly out. That pushing out of the belly can in fact push the rectus abdominis apart. Lifting heavy objects (or small children) incorrectly can also cause diastasis, as it can force the uterine wall to push between the abdominis recti, increasing the separation between them.

During a yoga practice, this “pushing out” of the belly may occur at any point in a woman’s practice, though it is most common when practicing poses like navasana (boat) where both legs are lifting, and deep back bends like urdhva danurasana (wheel) or ustrasana (camel) when the already-stretched abdominis recti may be pulled further apart by the uterus pushing them from behind.

The same is also true for women post partum, especially if they already have significant separation, as it takes up to four months for the hormones to dissipate – leaving the abdominal muscles stretched, soft and vulnerable to increased separation.

How can a woman tell if she has a diastasis? Have her lie on her back, with knees bent, feet flat on the floor. While having her draw in her transverse abdominals, have her lift her head and shoulders off the floor. Place your hands along the linea alba (the center seam of the rectus abdominis), with one hand below the navel and one hand above. Using fingers, gently press along the linea alba, feeling for softness or a bulge along that center seam. If two or more fingers can fit in that soft spot between the separated abdominis recti, it is considered a diastasis.

There are a few key actions which can help protect against this severe separation. The first is simply being mindful, staying aware of the abdominals, and gently drawing in the transverse abdominal muscles (the girdle-like muscles of the abdomen) to keep the abdominis recti in place. This mindfulness should not be isolated to one’s yoga practice, but rather be ongoing in daily life. It is also important to avoid movements (like kicking up out of bed, or practicing a full boat pose) which may encourage separation of these muscles. The third, and perhaps most important action is strengthening the transverse abdominals, which will help keep the rectus abdominis in place (or return to its proper place once separation has occurred).

During a prenatal yoga practice, it is important to continue practicing uddiyana bandha, which keeps the transverse abdominals gently engaged throughout the practice and will therefore keep those muscles toned and help keep the rectus abdominis in place. If a woman is finding it difficult to maintain uddiyana bandha in a particular asana, she may need to modify the asana or ask her instructor for an alternative asana to practice.

Many women also find it helpful to add to their personal practice specific ‘exercises’ which can help to keep the transverse abdominals strong. For example, while sitting in a comfortable seated position, have the woman slowly draw her belly in using her transverse abdominals. Have her hold her belly there – either counting out loud to 100, or for 100 breaths. She may use ujjayi breath if she is comfortable doing so. Ideally, she can practice this 2-4 times in a row each day, with a few deep, cleansing breaths in between each set. Once she feels comfortable with this practice, she can add to the practice a release/relaxation of her pelvic floor muscles. The combination of engaging the transverse abdominals while releasing the pelvic floor muscles can be extremely effective in maximizing uterine contractions and assist her in pushing the baby out during labor and delivery.

To tone the transverse abdominals in a different way, she can “pulse” the transverse muscles – much as she would automatically while coughing. It is helpful to have the woman make a sound like “huh” or “sssss” on the exhale, during the pulse. Verbalizing sound not only ensures that she is breathing (since she will need to inhale following the sound) but also helps her become comfortable with making sounds, which can be extremely helpful during labor and delivery. In fact, there is a connection between the throat and the pelvic floor – so deep relaxed sounds resonating from the throat, as well as the relaxing of the throat which occurs during ujjayi breath, can actually help a woman to more effectively open the birth canal during childbirth.

These practices will not only help keep extreme separation at bay, it will also mean a more speedy post partum recovery, allowing her belly to return more quickly to its pre-pregnancy shape and tone. They can also be useful in healing a diastasis post partum, both to increase tone in the transverse abdominals and to encourage the separated muscles back together. Once the separated muscles are back together and are strong enough that the woman is no longer prone to pushing them out, she can feel safe reincorporating poses like navasana and deep back bends into her yoga practice – which will in turn increase her muscle tone and flexibility. The process may take time, but with care and dedication she will see a positive change without invasive surgical intervention.

About Lisa Tunick Boward
Lisa has been practicing yoga in one form or another most of her life. She is a Registered Yoga Teacher through the Yoga Alliance, completing her teacher training under the guidance of Suzanne Leitner-Wise and Margaret Townsend in the Advaita Yoga Teacher Training Program in Washington, DC. She also holds certifications as a prenatal, labor and delivery and post partum yoga instructor in the Barnes Method:Yoga For Two and as a prenatal instructor through YogaFit. Lisa practiced yoga through both of her pregnancies, and after, finding yoga to be a wonderful physical and emotional preparation for childbirth and motherhood. When she's not teaching, practicing or writing about yoga, she can often be found hiking, camping and bicycling with her husband Max, daughter River (4) and son Solomon (2).

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