[MsBlack]

I have seen belly binding for ab weakness, and support belts/wraps used for pelvic stabilizing, to do wonderful things, and yet--I want to discuss the limits of their usefulness and when a good thing might not be such a good thing at all.

For instance: say a mom, after her first birth, shows a small diastasis of ab erector muscles--a finger width or so. Is it appropriate, in your professional opinion, to tell her that in future pregnancies she should start wearing a belly binding support at 16wks, and to wear it all day every day until birth?

If so, please explain. If not, please explain.

Also, knowing of course that moms vary quite a lot in their willingness to do 'more' for themselves to remedy/strengthen 'problem areas' in their physique (whether pelvic, ab, or both), please tell me the sorts of things you recommend by way of self-healing/self-management of issues apart from thngs like support garments.

I'm happy to hear from moms with experience in this, just please indicate if you are a birth pro or not (one thing that drives me a tad batty in this forum is that some posters do not indicate whether they are pros or not....I like personal, anecdotal info, just want to know the basis of info shared).

Any/all links/books/pros relevant to this topic will be most appreciated!

thanks in advance

 

[Surfacing]

:

 

[Mrs.aLifeofReilly]

I'm a doula and student midwife, but this is coming from personal experience.

With my last pregnancy I had diastasis recti, and it was just casually mentioned to me by my midwives and then let go. After the birth I asked about it and getting some sort of support belt or excersises to do, and was told that they really only felt things were necessary for moms who had cesareans or were multips. I didn't know much then, so I dropped it as well.

Now this pregnancy, the diastasis showed up early, and large. By 14 weeks there was a visible separation (I'm talking several finger widths) and I'm now dealing with a lot of pelvic pain. My homebirth midwife this time around was fantastic about helping me manage it. When it was first noticed she said I would probably feel more comfortable with a support belt at some point during the pregnancy and is having me do pelvic tilts to ease some of the discomfort. I recently told her the pain was worse, and that it was probably time for a support belt and she told me what kind would probably be best for my situation.

I do wish that my previous midwives had done more education/explaining about the condition and gave a little more credit to my questions about how to resolve the issue. I don't think pushing excersises or support gear on every women who shows some evidence of it is necessary, but certainly explaining it well and talking about the options would be appreciated by most women.

 

[sevenkids]

I'm a Midwife.
I'm a big fan of support belts, especially for multips. If a mom already has a diastasis recti, she's probably going to be more comfortable with support than without, but all day, every day? Not necessary, and pretty itchy and annoying. Most moms find they don't really need to put it on until mid/late morning or unless they're on their feet all day.

Preventing DR is better, and I do ask moms to take notice of how they are getting up, I suggest they roll to their sides and push up with their hands. When they are laying down for measurments and FHT's, I ask them to lift their heads and look at their feet. You will be able to see along the linea alba where the muscles are beginning to seperate/stretch thin. I explain what DR is and why it's a good idea to roll to their sides when getting up so I don't see a whole lot of it in my practice.

PP, I like moms to wear something supportive for the first few days, Spanxx or bicycle shorts or something, they feel better and can get to the bathroom without feeling like they're going to pass out or get that 'my guts are falling out!" feeling.

After the birth, and after all lochia has completely stopped for at least a week, ease into excercising, practice GOOD posture, holding the stomach in and keeping the back nice and straight will usually do to faciliate healing a mild DR. Doing crunches or pilates can make it worse or create a hernia until the seperation has healed a bit. If it's more than 3 fingerbreadths, then a wearing a support belt while doing anything strenuous (lifting or excercising) will be helpful until some abdominal strength is regained.

 

[mwherbs]

most of my recommendations would be for non- pregnant women- yes some exercise will and can be started in pregnancy but not much and really the work should be done before all the stretching and expansion has started--yoga, belly dancing -- Elizabeth Nobel's Essential Exercises for the Childbearing Year 4th ed.
shoes too- get use to flatter soles and do some posture adjustments- some women have such a degree of sway in the back that probably better off seeing a physical therapist to get a movement and exercise regime --to change body mechanics.
what i have seen in more recent years that I didn't use to see primips with pendulous abdomen, I use to only see this in the gals having their 3-4th+ baby so when I see baby, not just panus hanging over the sympthus pubis I do have a concern -- but recommending support so early it would have to be because I saw it enlarging or if mom was having some SI pain and her cartledge was already soft and getting softer--
my old midwifery partner when she was pregnant would end up on crutches because her connective tissue just soften up so much that she couldnt walk around- I think that sort of thing you really cant combat easily with any kind of exercise- she wasn't over weight and she was in pretty good shape but I think that this is different than what you are asking about-- have your gal get Elizabeths book and see if some of the stuff doesn't help

 

[MsBlack]

Thanks, people--

So far, you're saying the kinds of things that I think about this. That it is good to note any diastasis after birth (6wk checkup), explain it, and make recommendations about exercise for gentle toning of abs, future pregnancies and the potential need for some extra support (binding).

Mrs ALife--sorry that your earliest HCPs did not explain the diastasis and how you might heal it or at least keep it from worsening.

I've been discussing this with another mw I know, and a chiropractor also--mainly, whether or not someone with 1 fingerbreadth of separation needs to wear support all day every day, starting 16-20wks along. The mw says 'yes'; the chiro says 'no'--agreeing with me that this much support is likely to cause further weakening of the abs. The mw did say that she has discussed this with several chiros over the years, and the opinions have been divided.

Thing is, I would not want any woman to believe that once diastasis starts, that there is no way to correct it. Nor would I want to make a recommendation that I worry will only make the problem worse over time.

anyone else?

 

[mwherbs]

first off I would try not to have a conflict with another mw-- and that is probably the hardest thing. as for changing this particular situation it sounds like the client needs to decide what advice to follow and then let that be known-- for further/future people maybe some education from the outside- someone who does some belly binding and who also recommends exercises-- and has experience with the techniques so the training will be fitting and useful, and not a I told you so, we just want some balance -- and the truth is that some moms will probably NEVER do the exercises we recommend- and I still want those bellies supported and pulled in so that the baby is funneled into the pelvis-- KWIM
what about someone who does that Mayan massage? they may be able to teach a variety--
and the thing is that in some cultures wearing a belt or binding the belly happens all the time so I am not going to completely condemn the practice, because I really don't know everything

 

[Jane]

I show exercises post partum if there is a diastisis, or show the mom that there isn't one and her body is recovering so well (everyone usually loves to hear that).
My advice is to try one and if you like it, it's good for you. If you can't stand it - it's not for you. I just don't think that ALL supports work for ALL problems. The wrong support just isn't gonna help. There's lots of reasons for diastisis - inate ab weakness, twins or poly with a previous pregnancy, grand multipara status, poor posture, lack of interval between pregnancy, poor exercise form (stregthening them apart), hernia, etc. Any ol' support isn't gonna help each of those problems. The supports seem to be designed for women with back pain, although they seem to help a few other things.
I'm rambling now...

 

[MsBlack]

Thanks, mwherbs--

You are right that not all women will do anything to tone their abs (or exercise at all)--and yes, support bindings have been around awhile and in many places. Not saying it's 'wrong'--the point for me is more about providing good, thorough info: "you are starting to have ab diastasis; this can be fixed w/exercises and that's the best fix for the long run. You can also use a support belt". A woman chooses what to do--and IMO best choices are made with enough info.

Amazingly enough, some mws will make directives without much explaining reasons, nor teaching about options for dealing with something like this--and will exert force of will to gain compliance from clients. Impossible to say if this particular directive was made out of mw's lack of understanding (not actually knowing that diastasis can be remedied w/exercise) or instead, out of her belief that women just *won't* exercise and so need to be told what to do to save them from themselves (wear the support).

No conflict among mws presently speaking of this mom--the mw mentioned earlier was one consultant. The important difference of opinion is between mom's past mw and present one--so more info and opinions are being sought, IRL and here. As ever, I appreciate you sharing yours

 

[MsBlack]

Quote:

Originally Posted by Apricot I just don't think that ALL supports work for ALL problems. The wrong support just isn't gonna help. There's lots of reasons for diastisis - inate ab weakness, twins or poly with a previous pregnancy, grand multipara status, poor posture, lack of interval between pregnancy, poor exercise form (stregthening them apart), hernia, etc. Any ol' support isn't gonna help each of those problems. The supports seem to be designed for women with back pain, although they seem to help a few other things.

Thanks for adding this, Apricot--really important to understand this! I mean, I'm not going to necessarily argue with a mom who is doing something that she feels good about (not unless I am certain it's 'bad for her/baby'). But I at least want to know ...and want to be able to share with clients....solid info wherever possible.

 

[sevenkids]

There's a lot of debate about what is the best way to heal a diastasis, even among personal trainers and fitness pros. Some recommend wearing support during excercise, some advise no support, some advise crunches, some say no way. Everybody's got their own, professional opinion.

It does tend to get wider and wider with subsequent pregnancies, even a 1 fingerbreadth DR is going to get wider in a second pregnancy unless mom is being careful about her posture and how she gets up. And not all DR CAN be fixed with excercise, some do require surgery. Also, the wider it gets, the risk of hernia increases. I have seen at least one mama with a small DR (one fingerbreadth) develop a painful hernia. Let's be real, we can't expect a new mother to not lift, vaccuum, sweep, mop, do laundry and otherwise strain her abdomen.

In my very ethnically and culturally diverse practice, I have noticed over the years that the women who practice traditional belly binding during pregnancy and PP do seem to bounce back into shape much sooner than the women who don't.

 

[storychick]

I do postpartum support/parent education, and this is something I bring up with my moms. I recommend Elizabeth Noble's book, as well as Lose Your Mummy Tummy by Tupler (dumb title, good exercises!), and give out handouts from those. I also have a pelvic floor PT that I have experience with locally here that I refer clients to, if they like. I find a lot of them don't know anything about it, or what they can do, so I just throw it out there as a possibility/something to think about and they come to me or follow up with their midwife if they are concerned.

On a personal note, it was something that was discussed in my pregnancies, and I was resistant to a support belt until my last pregnancy despite having DR since after my first! I finally went to get one about 2/3 through, after a lot of pubic and back pain, and when she put it on me I told the lady "How much is it, because I'm not taking it off."

I counsel women that if the support helps, use it, but to listen to their bodies -- and in general, to take the need of a support as a sign that they need to be doing more to help themselves (eg exercises or professional help) long term. Whether they are any better about taking my advice than I am with my own self, I don't know. lol My last babe is 2 now and I am only now feeling "together" enough to start really concentrating on it for myself (and luckily I am really feeling like the Mummy Tummy exercises are helping). So I give the info to my generally newly postpartum moms with the idea that they will stash my handouts someplace and pick them up again in a year or two, perhaps when they start thinking of another baby. Initially postpartum they are too overwhelmed with just surviving and all their focus in on baby, they are often not ready to admit they have needs too.

OT -- Apricot, you are in my neck of the woods, do I know you?

 

[MsBlack]

I really appreciate that you all have got me thinking more about this topic.

For one thing, I'm thinking now about how we stand erect rather than going on all 4s mainly, as other primates do. I've read various things over the years about how this may lead to some issues for pregnancy and birth--such as pelvis problems and DR (that's diastasis rectis? sorry, I can visualize this issue very well but don't always know proper terms--- and in my A&P class we glossed over the muscular system totally). Which makes traditional belly binding seem like a sensible development--tho now I'm curious about which cultures use this 'traditionally' and how far back it goes (that is, is it a more modern development, conceived by women suffering the problems inherent in 'too much civilization' in the forms of chair sitting, less walking and so forth? Or does it go further back than that?)

My mw friend who thinks continuous binding from early on is a good thing, says that the belts only provide 'support' but do not actually reduce the amount of work that the abs must do. That therefore, wearing a belt is NOT going to worsen the condition/further weaken the abs. While at this point I'm not accepting that that support has no ill effect on the abs, I can imagine at least that it's not doing all that much harm. Not sure....just allowing for the possibility.

Sounds like there is no real concensus with this--and that, while not as satisfying as a pat answer, is more good info to have and share. When speaking to women about anything impacting their health, I like to be able to say whether or not some idea is well-proven or not. Just part of teaching and of informed consent.

anyone have good links to share on belly binding practices?

thanks again all--do please share further stories/theories/opinions.

 

[mwherbs]

they do it in China and Japan and I don't think it is a recent development- if you take a close look at the formal clothes it includes belts even long ago--I know that there are other cultures including the folks from my region I just don't know how far back that it goes in the culture- and I do know what you mean because old medical care does become folk medicine rather quickly- that is how lead powder can still be found as a "traditional" remedy when it was originally a physician remedy- but I do think that there is something older about belly binding

 

[MsBlack]

Interesting that you should mention China and Japan because (no offense to anyone) those would be 2 cultures which I would call 'overly civilized' for what--way longer than any other existing culture, right? Overly civilized btw, to me refers to more and more highly structured and ritualized social rules, gender roles, more and more reliance upon human inventions and less upon sustainability and harmony with nature, etc. Chinese and Japanese women both lived 'traditionally' with far more restrictions upon their bodies and conduct, for far more generations than most other world cultures. Can't help but think that there would be some negative impact upon their bodies eventually--because as far as I can tell that is a natural consequence of increasing development of civilizations.

I am not a fan of the flush toilet, chairs, bras, high heeled shoes, highly specialized social rules and gender or class roles, the industrial revolution, modern medicine, people living together on a large, mass scale (cities)--just to say that when I mention 'overly civilized' I am only speaking of my personal opinion about those things. Every world culture is beautiful and worthy in it's own ways. Some are just more appealing to me than others--and my personal bent is toward smaller scale and less specialized and industrialized, more simple and harmonized with nature.

It does appear to me however, that the more developed any civilization becomes (and all present civilizations are in this camp, not just China and Japan by any means!), in the ways I pointed to, the less healthy people are. We might live longer....we might 'save more babies'...but we are increasingly unhealthy nonetheless.

I guess I'm hijacking my own thread here....

Just another interesting topic to discuss someday I guess.

 

[rhiandmoi]

I think not wearing a maternity girdle/corset/band is a modern thing that came with the phasing out of regular girdles and corsets. I don't know that maternity girdle/corsets/bands were traditionally worn to prevent/treat DR, probably they were mainly to promote a certain aesthetic or to "get your body back to normal" faster. There are samples of corsets and maternity corsets going back to the 1500s.

 

[mwherbs]

I have done some reading in the past on this but sadly haven't retained much- in any case I can understand what you mean but I guess we could play this out a bit it seems that "belts" were worn by men and women in many cultures and can be found in all sorts of artifact caches - to know if they were worn specifically for pregnancy... harder to figure out

 

[sevenkids]

Quote:

Which makes traditional belly binding seem like a sensible development--tho now I'm curious about which cultures use this 'traditionally' and how far back it goes (that is, is it a more modern development, conceived by women suffering the problems inherent in 'too much civilization' in the forms of chair sitting, less walking and so forth? Or does it go further back than that?)

Asian cultures, yes, so do Caribbean and central/south American women. I've had a few African an Middle Eastern ladies who also bind their bellies. I think it may have originated less from modern sedentary lifestyles back to the days when women had to continue their every day activities during and after pregnancy that were HARD work, like carrying enough water for the family's needs on their heads, or firewood, for example. If a heavily pregnant woman, no matter how fit she is, is carrying extemely heavy loads, it makes sense she would need support to continue to be able to perform her household duties. Likewise, a modern, sedentary woman, heavily pregnant with poor abdominal tone, may find her ab muscles stressed by simply being pregnant, even though she's not carrying water or firewood on her head or lifting heavy bundles.

 

[Jane]

Quote:

Originally Posted by storychick OT -- Apricot, you are in my neck of the woods, do I know you?

Not yet! Kat doesn't ring a bell. I'm a recent SMS grad.

 

[Joyce in the mts.]

I don't pretend to know much, but...

What about use of a rebozo?

Just thinking out loud.