The Fourth Trimester: Understanding Diastasis Recti and Healing Gently After Birth

WELLNESSPELVIC HEALTHMINDFUL MOVEMENTMOTHERHOOD

Jodi Bremner PT, Founder of Hervana Women's Wellness

5 min read

A mother holds her newborn baby during the fourth trimester, with text about understanding diastasis recti and healing.

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Your fourth trimester is a season of recovery, not a test

After birth, it’s easy to feel pulled toward advice about “getting your body back.” I prefer to think about recovery as getting to know the body you have now, with patience and care.

Your body has been through pregnancy and birth. You may also be healing from a caesarean incision, perineal tearing, or other physical changes. Add feeding, interrupted sleep, drastic hormone changes, and the repeated lifting and carrying that come with caring for a newborn, and it makes sense that returning to movement can feel different from what you expected.

I don’t believe you need to earn rest before you deserve it. Rest, practical help, and time to heal are part of recovery. There is no single timeline that applies to every birth or every body.

That doesn’t mean you have to avoid movement or wait until you feel “perfect” to seek support. It means we can start with where you are and make room for your own pace. ACOG’s guidance on exercise after pregnancy also emphasizes a gradual return, guided by how you’re feeling and your individual circumstances.

How postpartum pelvic floor physiotherapy can help

In postpartum pelvic floor physiotherapy, I look beyond the abdominal gap. I want to understand how you’re managing daily life, what feels difficult, and what you’d like to return to, whether that’s lifting your baby with more confidence, walking comfortably, or getting back to a favourite activity.

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Pelvic Floor Physiotherapy

Upcoming Experiences

A peaceful mother naps in an armchair next to her sleeping newborn baby in a wicker bassinet.

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The weeks and months after birth can hold many things at once: tenderness, exhaustion, love, uncertainty, and a body that feels both familiar and new. There’s no single way the fourth trimester is meant to feel. And there’s no deadline for feeling like yourself again.

If you’ve noticed a soft ridge or bulge along the middle of your abdomen when you sit up, lift your baby, or change position, you may be wondering about diastasis recti. It’s a common change after pregnancy, and it doesn’t mean your body has failed or that you must rush to “fix” it.

As a pelvic floor physiotherapist, I want to offer a gentler starting point: healing is not a race toward a smaller gap. It’s a gradual process of understanding how your body is working now, finding the support you need, and rebuilding confidence at a pace that respects your recovery.

What is diastasis recti?

During pregnancy, the connective tissue along the middle of your abdomen stretches to make room for your growing baby. The two sides of the rectus abdominis, the muscles often called the “six-pack” muscles, may sit farther apart. This is known as diastasis recti, or abdominal muscle separation.

It’s one of the body's brilliant adaptations to pregnancy. The distance between the muscles is only one piece of the picture. When I assess someone, I’m also interested in how the abdominal wall responds to movement and pressure, how it feels, and whether symptoms are affecting everyday activities.

For example, you might notice a ridge or doming along your midline when you get out of bed, lift a car seat, or reach for something on the floor. You may feel less supported through your trunk. Or you might have no symptoms at all and simply be curious about what you’re noticing.

The shape or width of a gap alone doesn’t tell the whole story. Your comfort, strength, function, and goals matter too.

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A woman practicing mindful breathing and yoga in a cozy home setting while sitting on a mat.

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An appointment may include a conversation about your birth and recovery, and a movement assessment tailored to you. With your permission, I may observe how your abdomen responds when you breathe, roll, stand, or lift. We can also talk about pelvic floor symptoms, back or pelvic discomfort, scar healing, and the movements that matter most in your day.

An internal pelvic floor assessment is not automatically required. If an internal assessment is relevant, I explain why, discuss your options, and ask for your consent. You can ask questions, pause, or decline any part of an assessment.

Together, we can explore a plan that may include breath and movement awareness, gradually building abdominal and pelvic floor coordination, and adapting everyday tasks while your capacity grows. The goal is not to chase a number or copy a generic exercise plan. It’s to help your body meet the demands you place on it with more comfort and confidence.

A gentle way to begin reconnecting

If you’ve been cleared for gentle activity and it feels comfortable, you might pause for a few unhurried breaths in a supported sitting or lying position.

Let your shoulders soften. Notice your ribs as you breathe in and out. You don’t need to pull your belly in, brace hard, or make anything happen. Simply noticing your breath can be a small way to reconnect with your body in a season when so much of your attention is going elsewhere.

When you move through a daily task, notice how it feels. Does getting up from bed feel easier if you roll onto your side first? Does lifting your baby feel more comfortable when you bring them close before standing? These observations aren’t a test you can pass or fail. They’re useful information, and they can help guide a conversation with a physiotherapist.

If an activity brings on pain, a persistent bulge, pelvic heaviness, or leaking, you don’t need to push through it. You can adjust the movement and ask for individual guidance. Some activities may need to be modified while you recover; that doesn’t mean you’ll need to avoid them forever. With support, movement can progress as your comfort and capacity change.

For a little more about the connection between breathing and abdominal recovery, you can read my earlier Wellness Journal post, The Missing Link in Diastasis Recti Healing: Why You Need to Breathe Better, Not Crunch Harder.

When to seek extra support

Consider connecting with a healthcare provider if the separation or bulging concerns you, if you’re unsure how to return to activity, or if symptoms are getting in the way of your day. You don’t have to wait until something feels severe. Support can also be helpful when you simply want a clearer picture of what your body needs.

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A female therapist listens intently to her client during a professional mental health counseling session indoors.

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Seek prompt medical advice for significant or worsening pain, a new or painful bulge, concerns about a healing incision or wound, or symptoms that feel sudden or worrying. A physiotherapist can assess movement and function, and can help you decide when another healthcare provider should be involved.

At Hervana Women’s Wellness, I offer pelvic physiotherapy and holistic wellness for women through many seasons of life. My approach is one-on-one and collaborative: we make space for your questions, your story, and the kind of progress that feels meaningful to you. You can learn more about our pelvic health physiotherapy or connect with us when you’re ready.

A softer measure of progress

Healing after birth may not move in a straight line. Some days you may feel stronger; other days, tiredness or tenderness may ask you to slow down. Both belong in the story.

Diastasis recti physiotherapy isn’t about judging your body or demanding that it return to a previous version of itself. It’s about understanding how your body is functioning, responding to what it needs, and finding steady ways to rebuild strength over time.

You are allowed to take this one step at a time. You are allowed to rest without earning it. And you deserve care that sees more than a gap.

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If you have a quiet moment today, place a hand over your ribs and take one comfortable breath, just to meet yourself where you are.