Of all the physical indignities of having a baby — the delivery, the breastfeeding, the mesh undies that made me feel like an enormous wounded sea creature snagged in a tiny net — the postpartum stomach pooch is among the worst. For many of us, our distended abdomens deflate eventually, given time and maybe a little exercise. But for everyone else, the pooch remains staunchly... poochy, an unpleasant remnant of a difficult time. It's a condition called diastasis recti, or the separation of one's abdominal muscles, and, at least it my case, it made me look six months pregnant well after delivery.
Illustration by Jim Cooke.
If you Google "diastasis recti", you'll find a wealth of information on exercise programs you can do to try to knit those muscles back together. According to the internet, these exercises work for a lot of people, but for me they did absolutely nothing (and I was diligent). My OB, who's not one to push surgery, told me that she had not seen a gap as big as mine come back together with exercise alone. But she didn't have a lot of information on what the recovery was like, and there isn't a ton of information online aside from a few horror stories on blogs. So here it is: What to expect after surgery for diastasis recti.
1. Your post-surgical abdomen is not going to look like your pre-kids abdomen.
My surgery, which included an umbilical hernia repair in the abdominal wall reconstruction, left me with a thin scar from hip bone to hip bone and a small perimeter scar around my belly button area. It isn't especially pretty. So if you have a small pooch that isn't affecting you physically and isn't visible through clothes, I'd say don't bother. You're trading one naked problem for another naked problem. It's only worth it if you want to feel better (and look better in clothes).
2. Your insurance might cover it.
Mine did, after my OB wrote a letter to the surgeon that it was affecting my day-to-day life (difficulty lifting stuff, including my kids) and that exercise had not helped.
3. Ask careful questions if your surgeon offers a tummy tuck.
I declined the TT as soon as I heard the words "10 thousand dollars out of pocket". (I'm vain but not 10K vain.) But I'd seen pictures of tummy tucks online, and when I woke up in recovery and looked at my stomach, I asked the nurse (a very cheerful man who used to be an actor) "how is this not a tummy tuck?" he made jazz hands and trilled "fuuuh-reeee tummy tuck!" So perhaps it's impossible to do an abdominal wall reconstruction without doing a tummy tuck? Or at least something close enough to it that it won't matter to you. Ask your surgeon.
4. Lose any weight you want to lose before the surgery.
This is so they can trim away loose skin during the procedure. I know, ew. That said, I didn't even try to lose the baby weight pre-surgery, because I knew I would just gain it back. I can deal with being a little heavier than pre-kids, but I can't deal with a protrusion.
5. You have to be done having babies.
You can't repair the abdominal wall and then blow it out again with another pregnancy. Look into an iron-clad birth control method before you even consider the surgery.
6. The recovery is pretty unpleasant.
It's worse than a C-section. You'll stay in the hospital for at least a night and then go home with drains, which in my case stayed in for 10 days, and which require some gross maintenance. But worse than the drains is the back pain: Because your abdominal muscles are stitched back together so tightly (think of a corset that laces in the front), your back will hunch over. The back hunching was far more painful that the abdominal incision, though I managed pain relief with just Advil and Tylenol after a day or two. It's hard to explain, but the cinched-in ab muscles sensation is deeply, deeply creepy, and it lasts six to eight weeks. A year out, there are still patches on my abdomen that are only now regaining sensation.
7. You'll need time off work and child care.
You can't lift your kids (or anything else) for eight weeks. The surgery PA at the hospital told me she was waiting until her youngest kid was four before repairing her own pooch. I waited until my younger son was two and a half, and even that was pushing it. My husband did most of his care, and I didn't lift him, but every time he stumbled or jumped off something (which is every 10 minutes for a two-year-old), I would involuntarily lurch towards him, which was shockingly painful. (And, by the way: You really, really, don't want a toddler kicking you in the abdomen when you're reading or snuggling unless you want him learning a new string of choice swear words.)
As for work, I took one week off and worked one week at home, but I would say a better plan is more like one week off, two to three weeks at home, depending on the bumpiness of your commute and your level of fatigue. I took a bus and train ride at two weeks out, and the jostling was murder. And because your core is non-functional until you heal, you're going to get tired from even minor physical exertion and need to lie down.
8. Don't schedule it during allergy season.
If you're afflicted with seasonal allergies, wait 'til the season passes. I nearly overdosed on Claritin because I was so afraid of coughing and sneezing.
9. It's worth it.
If your separation and/or hernia is as uncomfortable as mine was — I couldn't build any back or core strength, which was affecting my posture; I was clumsy and slow when running; and my stomach was the first thing to touch my husband when we hugged or danced — and you just can't get over how your post-pregnancy body looks, it's worth it. I had mine repaired for reasons that were 50 per cent physical discomfort and 50 per cent vanity, but vanity and physicality aren't discrete things: I can run easily now (no more lumbering), and weight training and yoga actually feel like they're having an effect, so I feel better about my looks. Your mileage may vary, of course. Talk to your OB and do your own cost/benefit calculations. And stock up on Claritin.