So much for bringing calm back in to my online life. Once again I find myself disgruntled with the ‘Everyone-should-brace-after-having-a-baby’ camp. I think my feelings are well-placed, as it is our professional responsibility to get accurate information into the hands of both practitioners and the public. It is critical.
A blog came across my desk, from a highly regarded organization, that promoted the use of abdominal binding after pregnancy. If you have been around my blog or interacted with me long enough social media you know I am not a fan of applying a blanket recommendation on the whole postpartum population-like everyone should brace to prevent/heal diastasis or no one should plank (see here, and here). I know not everyone agrees with me (see here). That is cool, we can respectfully disagree. But we need to form our opinions and arguments based on accurately presented research.
While I was off the grid, a study came out that I saw quoted a bit around the web. One of the study findings was that 100% of women participating had a diastasis by the end of pregnancy. This was only ONE of the study findings. The authors had much more to share that gave important perspective to that 100% statistic. I hoped that if folks had actually read the full study, that the 100% finding would either be carefully presented or not at all due to the additional study results. Some of you may have heard this stat in blogs (like the one in my inbox last week) or posts. But, if this is all you have heard, then quite frankly you may have been misled by that 100% statistic.
Let me fill in the background of what you may have missed without knowing the study’s additional findings:
- The authors of the study set a very low bar for what constituted a diastasis. If a study participant’s abdominal gap width measured greater than 16 mm at about 1 inch below the navel it was considered a positive diastasis. 16 mm, that’s it. At 35 weeks gestation, 100% of study participants met the criteria. The mean was 64.6 mm.
- Please note: Traditionally, anything 20mm or less has been considered an acceptable gap width (or clinically: two-fingers width, approximately 2cm). More recently our conversation around diastasis has focused less on the width of the gap and more on the density of the fascia in between the gap and restoration of abdominal function. See learn.dianelee.ca for more information.
- At 6-8 weeks postpartum only 52.4% the study participants measured positive for diastasis, with a mean of 18.8 mm.
- At 12-14 weeks postpartum, 53.6% tested positive, with a mean of 17.2 mm.
- At 6 months postpartum, 39.3% of subjects measured positive for diastasis, with a mean of 15mm.
- None of the variables they measured in addition to the gap width were predictive of who would still have a positive diastasis at 6 months postpartum: age, BMI before pregnancy or at 6 months postpartum, weight gain during pregnancy, Beighton’s hypermobility score, baby weight at birth, abdominal circumference at gestational week 35 or exercise training level before, during, and after pregnancy.
- The presence of low back pain was similar for women with and without diastasis (27.3% and 27.5% respectively). This means that women with diastasis have the same chances of having postpartum low back pain as women without a diastasis.
So now you have all the facts. Please take that info into your discussions and as you form your own evidenced based opinions on what that 100% statistic means. If you are interested in my take on the study, continue reading….
So, if that is how low you set the bar, then yes, everyone would be positive for diastasis. But let’s all remember what a diastasis is. First and foremost, it is a naturally occurring thinning of the linea alba that allows a mom’s abdomen to give in order to grow a human inside. That growth and all its support mechanisms (uterus, fluids, placenta, etc) have to go somewhere, so that mom’s organs, still have room to operate. You want that linea alba to be there, you want give in your abdomen. So is a 16mm spread really “pathological” at the end of a pregnancy? How about 20 mm? Or 30 mm? You can guess what I think. We really need to sort out what is a diastasis we are concerned about and what is a diastasis that is a natural part of this baby making process and communicate this well to the public and practitioners. However, this is a research study, they had to set a baseline value. That ‘s cool, I get that. But let’s not turn that very low bar into a full on public panic.
The real number we should be circulating to the public is that at 6 months postpartum only 39% of participants had a diastasis. That’s it. A little more than a third of the women still had a diastasis at 6 months based on that low bar. Quoting the authors, the continued improvement over the postpartum period suggested “that at 6 months postpartum, recovery is still in progress.” That is such hopeful news!! Why isn’t that info in a blog in my inbox?? Let’s spread that piece of hope instead.
The other bit of good news was that all the risk factors we often associate with getting a diastasis, including baby size, BMI, abdominal circumference and exercise, did not predict who would get a diastasis and who didn’t. We need to really wrap our heads around that one! Poor moms won’t need to beat themselves up forever that they did something they shouldn’t have, ate more than they should have, etc. Can’t blame the baby either. This affirms how much we have to learn to make good recommendations.
Our shift towards including fascial density in our conversations about diastasis may hold some understanding why these risk factors did not hold up under scrutiny. The authors were measuring gap width, rather than fascial density. Restoring density to the fascia is critical to rebuilding the abdominal wall in order to manage pressure in the abdomen and restore abdominal function (as a part of a system). This can occur even if the gap doesn’t close all the way. But this fascial component is the X-factor that no one can predict. How well each woman’s fascia will dense back up after pregnancy is variable. My educated guess is that this variability is likely what is messing with the statistical significance of these risk factors, and needs to be a part of the conversations we have with women.
Finally, diastasis was not predictive of postpartum low back pain. That was interesting! For me this speaks to so many things, most notably it challenges our thinking about the status and activation of abdominals as the key to solving low back pain. Pregnancy and delivery impact the system of muscles and pressures that support our center, our movement, and low back, not just the abdomen. How all those muscles and pressures become imbalanced during each woman’s pregnancy must be addressed, not just what happened to the abdomen. A multifactorial program is key, and in some cases this may include bracing or taping when appropriate.
So tell me again why are we suggesting that everyone brace postpartum…I simply don’t get it.