I want to share a Great Question asked by Samantha.
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Q: A client of mine (pregnant) had a c-section on her last one and wants to know what happened below her belly button that made it so hard to lose her pooch. Is that diastasis recti, perhaps? I think she thought something was actually cut, a horizontal pooch. But they don’t actually cut the muscles in a c-section, do they? Just pull them apart?
A: In a c-section 6-7 incisions are made throughout the process. Although the abdominal muscles themselves are not cut, the fascia which connects them is cut and this allows the doctor to pull the muscles apart in order to get to the next layer of fascia. Who knows how many extra nicks happen during c-sections and where they happen. The key is with all of the incisions/severing of the body, all of the nerves are also cut. Separating the muscles causes nerve damage, loss of blood supply, and damage to the muscle itself. Without proper retraining of these muscles it is extremely difficult to get access to the muscles. Without being able to access the muscles it is very difficult to tone them, leaving them flabby or pooch like tummy.
But even with all of this, the most common reason for distended bellies, long lasting pooches is misuse or under-use of the core musculature that probably started way before she was pregnant. It seems 9 out of 10 pregnant moms we assess do not have access to their TVA or control over their pelvic floor muscles. Without access to these muscles the belly gets much larger, and the muscles continue to distend and become even more dysfunctional. Add a c-section to that and you have a great explanation to the never going away pooch:)
Also regarding diastis, she definitely could have had one, and if she did not before the c-section there is a chance she did after as they separate the muscles at the fascia where they attach. Sometimes the doctors make a few stitches to reattach the muscles to the fascia.
I feel many women have a feeling of relief their muscles are not cut, but in reality it is kind of misleading. Although a scalpel does not cut through the rectus muscles, the fascia that is attached to them is cut, and then the muscles are separated from the fascia by pulling the apart. This causes a separation. So whether it is an incision or a tearing or pulling apart, the results seem to be basically the same. A separation of the fascia and the need to either reconnect on their own or through stitches.
Here is detailed description of a c-section. You have to remember this is one example. Some hospitals may use a cautery that burn the skin and cut through all the layers at once instead of making all of the little incisions. With this method often the muscles are also cut. You should have her ask her doctor exactly what the c-section entailed.