There's a lot of information available about preparing our bodies for pregnancy and looking after our health while pregnant, but once the baby arrives, the focus shifts towards using our bodies to feed and care for the baby.
Post-birth recovery and possible complications don't get the same amount of attention or discussion. While we recognise that our bodies have to stretch to accommodate growing life, a postpartum belly can be confronting to look at. It's only recently that women have started championing the normalcy of showing their post-pregnancy bellies, with loose skin, stretch marks and Caesarean scars on full display. I remember feeling shocked, looking down at my deflated balloon stomach just days after giving birth to my twins by Caesarean.
I was later diagnosed with diastasis recti. This condition is when the left and right stomach muscles separate from each other, which can make women look pregnant months after giving birth, and can also lead to back pain and loss of strength in the core muscles. It can vary from only 1 finger space between the muscles, to several fingers space, and is more common for women who have a multiple birth, carry an exceptionally large baby or have lots of pregnancies and/or Caesarean births.
I had minimal separation, but sometimes the separation can be so severe that it requires surgery. A friend of mine, Roxy* who is a fellow mum of multiples, with 4 children and baby number 5 on the way, was one of those people.
"I had very mild separation after my first pregnancy, but then I fell pregnant with our second child only 12 months later. Two pregnancies in quick succession meant my body didn't really have time to recover properly. After our second was born, I had a 2 finger gap, which was bigger but still considered a normal separation, but then came the twins! At my 6 week post-birth check-up, my doctor told me that my separation had increased to 8 fingers width! He suggested that I see a women’s physio who specialised in diastasis recti," says Roxy.
But even after 3 months of seeing the physio regularly, and doing Pilates classes that focused on diastasis recti repair, Roxy still had a 7 finger gap and deep intramuscular separation. She'd also started to have problems with incontinence and back pain.
"I consulted with my GP who suggested that I see a diastasis recti surgeon.The surgeon told me that my fascia (the connective tissue that underlies your transverse abdominal muscles) had completely separated and no amount of breathing or exercise techniques would help," says Roxy. "My only option for repair was surgery which required a full week of hospitalisation."
It wasn't the easy option. Roxy had a slow recovery and wasn't able to stand upright for 4 weeks or do any lifting for another 8 weeks, which is difficult as a mum of 4. But she says the surgery was worth it.
"It took three months before I was able to resume somewhat normal activities such as carrying the kids or pushing a trolley," she says. "But my pre-surgery symptoms have completely stopped. I don't have pain or incontinence anymore."
Another mum, Bella* is struggling with her belly almost a year after her final pregnancy. "My stomach has the appearance of a pouch and no muscle tone, and my belly button is still out," she says. "I know it's because of having 3 Caesareans in 3 years, one of which was a classical incision instead of a transverse incision."
Classical incisions are unusual these days but sometimes they're necessary to give doctors better access to the baby during birth. In Bella's case it weakened her muscles, even before she went on to have 2 more children.
"I haven't been able to do much to correct the separation because I wanted to have more kids, but being regularly asked if I'm pregnant when my last baby is about to celebrate his first birthday is very disheartening," she says. "I've just started physio but it's a long road ahead and I still might need surgery anyway. I'd like to avoid it if I can."
Many people don't understand what diastasis recti is, even those who have it, and that it's actually impossible for some mothers to ‘snap back into shape’ due to the permanent changes pregnancy can have on our body. In the case of having a Caesarean or pregnancy complication, it's something some women have no control over, but it leaves them feeling damaged and self conscious.
If you know a mum who hasn't 'bounced back', don't assume it's because she isn't exercising or trying to lose weight (although finding time as a new mum to do either of these things is difficult). Sometimes we need extra help to put our bodies back together again. There's probably much more to her story than you know.
And if you're the mum suffering a loss of self confidence due to your body, and especially your stomach, not returning to how it used to look, be kind to yourself. Physiotherapy can help to strengthen your core, but some things just can't be reversed and that's when surgery might be needed. The changes in your body are proof that you did something amazing and are nothing to be embarrassed about.