Transcript: How to Improve Diastasis Recti & Aid Your Postpartum Recovery After Birth
This is a text transcript from The First Time Mum’s Chat podcast. The episode is called How To Improve Diastasis Recti & Aid Your Recovery After Birth and you can click on the link to view the full episode page, listen to the episode and view the show notes.
Helen Thompson: Being pregnant and giving birth is a dramatic time for women and taking the time to help your physical postpartum recovery is extremely important. I’ve interviewed a number of guests on First Time Mum’s Chat who have shared their expertise and tips on dealing with such issues as pelvic floor problems, postpartum back problems and diastasis recti.
This week’s guest Peter Lap has worked as a personal trainer over many years and found himself with many female clients in their 20’s. Some years ago, he made the decision to specialize as a postnatal exercise expert, so he could help women with issues such as diastasis recti, postnatal back pain and posture issues.
Peter found himself at the time of being the only personal trainer focusing on this area in Edinburgh, Scotland, where he is located and has been featured in magazines and media in the UK. Peter is also the host of the Healthy Postnatal Body Podcast, which I was privileged to be a guest on recently and I highly recommend listening to his podcast.
I’ll include a link to it in the episode, show notes, and I’ll let you know where they can be found at the conclusion. In this episode, you’ll hear Peter talk about the causes of problems, such as diastasis recti, and how you can help relieve them, the importance of breathing correctly and tips to improve your breathing, why exercise during your pregnancy can help reduce your postpartum recovery time.
And much more….
Helen Thompson: Hi, Peter and welcome to First Time Mum’s Chat. I enjoyed chatting with you on your podcast recently, and I’m looking forward to hearing about your journey from being a personal trainer to a postnatal exercise expert, and how you help women with their postpartum recovery.
Peter Lap: Yeah, sure. Thanks very much for that Helen, much appreciated. Basically in the olden days, we used to call it postnatal personal trainer. That is the olden days and terms were more simple back then. I basically specialize in anything to do with postpartum recovery, from a physical perspective. So talking things like diastasis recti, posture issues, pelvic floor problems, postpartum back problems and all that sort of stuff.
Peter Lap: Cause quite often these things are all linked and therefore, if you can fix one, you can usually fix the other. As for how I got into this. I used to be what we used to call normal personal trainer. Normal PTs, just , your standard personal trainer at the gym and had a large selection of clients that were female clients in their twenties. So 25 to 29 years old, for some reason they came to train with me a lot and I’ve always written a lot and I’ve always been well connected in the PT world and one of my American personal training friends kept complaining how he kept losing clients. He said, yeah, I have all these women that I’m training and then they give birth or they fall pregnant and I don’t have the right qualifications, so I can’t train them anymore. I said, well, that sounds to me, like there’s a fairly straightforward solution to that, and that is get your qualifications, right?
Peter Lap: That makes sense cause my clients wanted to keep training with me, but of course they also want to be safe and this was about 10 years ago and I’m not sure if you’re aware, but 10 years ago, postpartum health was really just not a thing. Nobody really did it. Even now it’s relatively poorly catered for and so I started that 10 years ago and before you knew it, I was like the only one in Edinburgh, which is where I stay in in Scotland. I was the only one doing it and I kept writing and I did some stuff for the BBC. You know, the British Broadcasting Corporation and yeah, before, you know, I just became the postnatal guy and that is ever since then that’s kind of just all I’ve done. Because I found that I simply could not manage to do more than just one speciality. There is so much constantly happening and changing in the postpartum health world when it comes to things like diastasis recti and back pain and, and pelvic floor issues that if you want to stay on top of it that’s all I can do, so that’s where I find myself now.
Helen Thompson: So you mentioned that you do back pain and I can’t pronounce it, diastasis recti. I know a little bit about that, but I don’t really know what that is. Is it to do with the muscles in the tummy where the baby’s being born and they stretch or I’m not sure.
Peter Lap: Yeah, pretty much, so diastasis recti is basically, they very much used to ungracefully call it ‘mum tum’. Now I’ve always hated that expression. It’s actually just a situation, a muscular condition, as I like to put it, that occurs when the internal pressure on the core is too much for the core muscles to deal with and the reason I phrase it like that I’ll come to in a little bit if that’s all alright, but that means that your six pack muscles and all the muscles underneath that start to move away from each other a little bit. And that means that that line along The linea alba, which is from your ribcage to your pubis to your pelvic floor, that straight line on which your belly button sits, that sheet, that is not really a muscular sheet, but that kind of separates and that stretches and gets thin and all that sort of stuff.
Peter Lap: Now, the reason I say internal pressure causes the thing rather than pregnancy is cuz men can also get it. No most people don’t. Quite often what you see as beer belly in men, that is actually something like that as well. So men that tend to look pregnant, can still have diastasis recti as well. The same goes for people in wheelchairs, get it quite a lot, because their core activation is usually quite poor and they have to exert a lot of effort getting in and out of the wheelchair. So I prefer to say it’s an internal pressure thing rather than rather than pregnancy, because it also means that the solution immediately becomes quite clear. The solution to diastasis recti is therefore by definition, either strengthening up the core or releasing that internal pressure, right.
Peter Lap: If the internal pressure causes the core to separate, then by definition, if we decrease the pressure on the core, then it will have a chance to start healing, which the easiest way to do that is by breathing properly as you exercise or as you lift stuff, and this is why breathing becomes so important.
Helen Thompson: Yeah. I’m aware that breathing is very important and it’s something that I know myself I’m not very good at. I’m not saying I’m not very good at breathing. We all breathe, but breathing properly and I’m learning to do that properly. Cuz I know when I do meditations and when I’m relaxing, if I breathe properly, I just feel it a lot deeper and it just feels a lot better and I’ve started doing what somebody’s told me was box breathing. That you breathe in and count to five, and then you let it out and you do that a couple of times, and then your natural breathing gets better. And I started doing that and it’s actually helped. So I know it’s something I definitely need to work with.
Peter Lap: Yeah, no, but it’s exactly that, and it’s quite interesting. It is something adults tend to be terrible at. If you look at toddlers, toddlers are amazing at all this sort of stuff, in the same way that toddlers are amazing at performing an exercise properly, such as a squat and all that sort of stuff. It’s something we seem to unlearn. It’s something we are naturally quite good at doing and then we unlearn it at some stage throughout our life. And it’s usually things like stress, things like putting a lot of strain on the body and bracing yourself, as in physically bracing yourself for something. That seems to be one of the ways that we kind of unlearn how to breathe properly.
Helen Thompson: Is it to do with a pelvic floor as well? It’s all linked isn’t it?
Peter Lap: Yes and any physio will tell you this. Everything in the human body is connected to each other, absolutely everything. And when it comes to things like diastasis recti and core issues and pelvic floor problems, these things are directly connected to each other. So the way I teach people to breathe is by doing something that we call the core breath, and that is actually exhaling what I call from the bottom up, contracting your muscles differently. What people tend to do as they breathe and you’ll probably find this yourself, is when they exhale they collapse on themselves a little bit and the top two abs, you know, the, so to speak, easy to get ab muscle, abdominal muscles, you almost move forward a little bit.
Peter Lap: Whereas what I’m trying to teach people to do is exhale from the bottom up. So you start contracting the muscles from the pelvic floor area and then move them up the way and that is actually a much better way to breathe and that then also allows you to start healing your pelvic floor. Obviously we need to exercise on top of that, right but it’s the easiest way. One of the most important ways to do it is by breathing properly and exhaling from the bottom up.
Helen Thompson: So if a mother’s just had a baby, how can she help that process? I’m assuming just after giving birth, it’s probably not the right time.
Peter Lap: Yeah. I always say that and this is all current medical advice as well. After about two to three weeks you can start doing your pelvic floor exercises and they are actually rather important. So then we’re talking things like kegels and all that, kegel exercises. The tricky thing about those is knowing how to do them properly. So I always say, just skip them for now. Just wait until you’re about six to eight weeks postpartum, depending on whether you had a C-section or not. C-section recovery tends to take a little bit longer. When you’re six to eight weeks postpartum in an ideal world, you’d book yourself in with a pelvic floor specialist that can show you how to do the exercises properly. I personally wouldn’t recommend starting any exercises until you’re about about six weeks down the line. And even then you want to do the right exercises, targeted exercises and do them very, very gently indeed.
Peter Lap: Postpartum exercise and this is one of those pickles that women are very much being told that everything about being pregnant and giving birth is all unicorns and rainbows. It’s gonna be magical and amazing. Exactly and quite often it isn’t, it is almost inevitably a very traumatic experience on the body and therefore what you need postpartum is some form of rehab. Think of it, as the body is, relatively speaking, a bit injured, postpartum. There’s a lot of muscles that aren’t quite working the way they should be working, muscles have switched off during pregnancy a little bit. This is why for women especially who’ve had that pregnancy waddle you know, when they’re really big and they start waddling like a duck almost, their glutes, the muscles in their bum, start switching off and disengaging a little bit. Activating those is a very steady process, but it is something that should be done before you really go back to exercises such as running and squats and I dunno, cross trainers or swimming and all that sort of stuff.
Peter Lap: So postpartum recovery is a very gentle process. This is why I always say, listen, it’s going to take at least three months for any good postpartum program to really kick in and give you a chance of almost being fully recovered.
Helen Thompson: A question I’m just asking you because I have no idea, but if you are pregnant and you said that their muscles disengage on your glutes, can you do anything about that whilst you’re pregnant? If you notice they’re disengaging, when you’re actually pregnant, can you do anything or will that damage your baby?
Peter Lap: Yeah. That’s an excellent, excellent question, cuz I, I wish more people would do this. Anything you do during pregnancy, is a bonus postpartum. Absolutely anything you can get in during your pregnancy. First of all, exercise during pregnancy is completely safe to do so. If you’re already used to exercise before you fell pregnant, you can kind of just keep doing what you were already doing up until your due date, a client trained with me one on one personal training and she was pregnant with twins and she squatted a hundred kilograms the day before her due date, cuz she wanted to get a session in with me and she said, let’s do some really cool stuff and that way she could tell everybody that she had a hundred kilograms on her back the day before her due date, which of course was through C-section and that sort of exercise really, really helps postpartum as well.
Peter Lap: I always tend to say that if you wanted to, if you were that way inclined, it’s probably not a bad idea to start your postpartum exercise program during your pregnancy. If you’re not used to exercising yet, things like resistance band glute kicks for your glutes, things like posture exercises and all the things that make up part of a good postnatal program are massively beneficial because it means that you can almost skip the activation stage of any postpartum program.
Peter Lap: So a good postpartum program tends to be made up of three things and that is the first part, not to be too boring, the first part is all about muscle activation, getting the right muscles to work at the right time. Think of it like waking somebody up from a coma, right? They need to learn to move again. That’s what we’re trying to do. Then they have the second part, which is all about strength and endurance, making sure that the muscles that are now working properly are strong enough to do what they need to do and then the last part is just, what else would you like to work on? What individual niggles do you yourself have?
Peter Lap: Because everybody is different. Nobody is exactly the same postpartum. So, in an ideal world, if you can swing it, if you can afford to do it, you’d be able to work with someone who can show you what would work for you.
Helen Thompson: That’s good advice cause I think starting when you are actually pregnant can probably help the process cuz I’m imagining, as your baby grows in your tummy, if you have been practicing all your pelvic floor muscles and your back muscles and your posture, it’s less likely you’ll have back pain.
Peter Lap: Yes you’re right in that the muscle activation is a lot better postpartum and especially with regards to back pain, postpartum back pain is hardly ever caused by the back you see, it’s almost always caused by the muscles at the front. And you’ll come across this a lot when you do any sort of massage sort of stuff, when people say, oh, this bit hurts. I know you obviously work with babies and all, but when people say this bit hurts, then you’re like, yeah, but that’s actually caused by something else and therefore the more you can keep your core especially active and your core muscles working, although you can’t really prevent diastasis recti right, the baby needs room to grow the baby’s gonna go and you can’t keep that compact. There’s just no strengthening it up to that extent. So that diastasis recti will happen but again, diastasis recti is always fixable. Almost always fixable, put it that way, 99% of all cases it is just fixable through exercise, it’s nice to know, I suppose.
Helen Thompson: Yeah, I think some mums when they’ve been pregnant, they’re very conscious of their bodies being fat and large and flabby, whereas some mums may not be like that. I don’t mean to be critical of any mum, but I’m aware of the fact that some mums feel it a bit better than others.
Peter Lap: Oh, absolutely and a lot of that is down to unrealistic expectations. Again comes back to this whole rainbows and unicorn ideas. If you look on social media and Instagram, you see all these famous people who have babies and 3, 4, 5 weeks later, they go back to looking amazing and even ignoring all the filters and all that sort of stuff and ignoring that they have perfect lighting and all that sort of stuff these people are likely to have people helping them with the baby, they’re likely to have personal trainers, they’re likely to have dieticians and throughout the whole duration of the pregnancy. I used to get this regularly with women coming to me saying, can you make me look X, Y, Z celebrity, usually an athlete. Can you make me look like that postpartum? No, because she didn’t look like that person prenatal either. And therefore I think it’s important to realize that it is okay to look different. I never talk about postpartum weight loss because I find it’s not useful and I find it’s a minefield also, because again, this is what women don’t get told enough, whilst you’re breastfeeding or expressing or anything like that you have a hormone in your body called prolactin that helps produce milk and just by having that hormone in your body, you are likely to retain 5 to 10 pounds of weight because that’s what the body thinks it needs. So going on any sort of postpartum diet to lose weight is going to fail by at least that 5 to 10 pounds.
Peter Lap: And I’m even leaving alone that it’s usually not necessary at all to go on any sort of diet postpartum, cuz these things tend to level out a little bit. So I talk more about muscle functionality and you know, you find you have a big round tummy. So not fat, but just round. That’s a muscular injury. That’s kind of all that is, there is no difference between that and breaking a leg and therefore, when you find yourself in that situation you get some help, right? You wouldn’t just walk a broken leg off hoping that it heals itself. But like I said, there’s a ton of help out there obviously. But if you are able to get some help with it, then I find most women are able to recover in a way that they feel confident and happy within themselves.
Helen Thompson: And finding somebody like you, who they can talk to and get support from rather than just, looking on the internet.
Peter Lap: Yeah it’s really difficult. I always say that there are three orders to things. If you can work with a pelvic floor specialist or a physio, or a personal trainer, postpartum personal trainer, that is always the first step, but, they’re not necessarily cheap as in not everybody can afford them. Then you have your online programs, a well designed postpartum program like I have, at HealthyPostnatalBody.com, when you came onto my Healthy Postnatal Body podcast and all that sort of stuff and that is then your next step and as in, if you can’t afford 700-800 pounds or dollars or however much it is, depending on where you stay, it can be significantly more expensive, then a good online postpartum exercise program will do the job. You just have to put a bit more effort in yourself because there’s no one sitting next to you guiding you through that process. The one thing I always tell people not to do is go on Facebook support groups, go onto YouTube and guess your way through it because that’s a surefire way to ending up disappointed. You know, a lot of things online say things like postpartum workout, diastasis recti safe workouts, and all that sort of stuff, but there’s a big difference between just randomly jumping about and it not hurting you and doing targeted exercise that will actually help you recover.
Peter Lap: It is quite important to make sure that you know that you’re going from A to B and as I always say that, if I travel down to London, you know, keeping this UK based, it really matters whether I start from Glasgow or from Edinburgh when I set my self up, cause the directions are different and that’s kind of what the difference is. I could, well randomly jump in a car and start driving in the hope I end up in London and that could well happen, but chances are it’ll take me a lot longer to get there and even bigger chances are that I’ll never get there and then I’ll just say to myself, well, see, it’s hopeless. Yes, exactly. I just have no chance of finding my way to where I want to be. There are a ton of good postpartum people online that I would always recommend, just get in touch with people.
Peter Lap: I get several emails a week from people that have no intention of training with me cuz you know, I’m in Edinburgh and they want some specific guidance that has nothing to do with my online program. So they just send me an email and I always help.
Helen Thompson: So if anybody wants to get in touch with you and find out about what you do, how can they go about doing that? Cause I know you’ve got a podcast because I was actually on that podcast, which I highly recommend.
Peter Lap: Well, thank you very much. Yeah. So we have the Healthy Postnatal Body podcast that kind of does exactly what it says on the tin. And that is kind off the back of the healthypostnatalbody.com website. So I found that when I did all my PT in Edinburgh and I was writing a lot, I was getting emails from people outside Edinburgh and they said, there’s just no postpartum expert in my area, or I can’t afford it. Cuz if you live in London, for instance, you’ll easily pay 250 to 300 pound an hour and that’s a fortune, that is so expensive and there were one or two good programs available, but they also tended to be expensive. A lot of online postpartum programs tend to be $400 or $500 and I thought that this is it’s a little bit outrageous, just from a women’s health perspective.
Peter Lap: That’s something that 80% of women who give birth have diastasis recti and I mean, in Edinburgh alone, which is like I said, where I stay, 5,000 women a year give birth. In Scotland it’s about 70,000 – 75,000 women. If 80% of them have postpartum issues, it shouldn’t cost them hundreds of pounds to fix up.
Peter Lap: And it almost sounds obvious. Right? So that’s why I set up healthypostnatalbody.com, which is my little online program, which is free for three months and after that it’s eight pounds or $10 a month, but you can cancel at any stage. So what I have a lot of people do, a lot of women sign up on day one, they cancel on day one, but they still get three months programming and as part of that, they can also just send emails to firstname.lastname@example.org and ask me anything they want to ask. It seemed to me that would hopefully brings us a bit closer to something, because I think this stuff should be available on the NHS (National Health Service) to be honest. I think your health service should be able to provide all women with postpartum physio like they do in France and like they do in other countries. I don’t think they do it in Australia. They don’t do it anywhere, other than France and I know Sweden and Norway do it.
Peter Lap: I think we covered quite a bit and thanks very much for having me on. Much appreciated.
Helen Thompson: It’s a great pleasure and thank you for being a part of the podcast.
Helen Thompson: Peter certainly has lots of expertise when it comes to women’s postpartum recovery and I learned a lot for him during this episode. I encourage you to check out Peter’s Healthy Postnatal Body website and his monthly membership. As he mentioned, he offers a free 13 week trial, so why not sign up and check it out.
Helen Thompson: I’ve included links to Peter’s website and podcast in the show notes, which can be accessed at MyBabyMassage.net/podcast/087.