Diastasis recti, the history of round bellies, and making medicine about aesthetics

Disclaimer: I am not a doctor, I am not offering medical advice.

Last week I had the all too familiar experience of a shockingly well-targeted ad popping up in my facebook feed. This one was a video promoting an app to help correct diastasis recti. My reaction was a mix of excitement and suspicion, and the more I read about Every Mother, the company behind the ad, the more anxious I became.

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A screenshot I took of the facebook page for Every Mother on 1/24/2020.

I have diastasis recti as a result of my twin pregnancy in 2018. It is a condition that I would describe as debilitating at its worst and exhausting at its best. Six weeks postpartum (the point at which doctors consider you to be healed enough from the actual process of birth to resume regular physical activity), I could still barely sit up straight or walk at a normal pace and I developed persistent pain in my shoulders from the strain. The OB who delivered my twins told me at my 6 week postpartum visit that I should immediately find a good PT who specializes in women’s postpartum issues and pelvic floor rehabilitation.

Despite her recommendation and prescription, I’ve had a hard time getting the treatment I need for this condition, in part because I was barely at home in 2019, but mostly because there isn’t a well-accepted recovery plan for diastasis recti that is covered by insurance. While there are physical therapists who specialize in treating this and related pelvic floor issues, they typically work outside of healthcare networks. Most physical therapy that is covered by insurance is rehabilitation from injury or surgery, and isn’t geared toward complete recovery, but instead toward reducing the problem enough that it doesn’t inhibit your daily functions – in short, it’s there to get you back to whatever you were doing when you injured yourself. I did physical therapy with an excellent, caring, and resourceful PT for 3 months once I moved to California, but I found that while her regimen helped prevent me from hurting myself further and guided me toward the kinds of activities that would continue to help, it didn’t do much to solve the problem. Instead, I made an incredible amount of progress when I stumbled onto a pelvic floor yoga class – not something that’s typically offered either, but at an affordable studio, the cost per class was less than my insurance copay for physical therapy. I also found it significantly easier to do the yoga routine at home than I had with my physical therapy exercises. But then I left home for nine months and couldn’t keep up with the regimen.

Once my research year was done, I went back to my doctor (a different one than the OB who first sent me to physical therapy) to ask for her to renew my prescription. She told me that I wouldn’t get shoulder pain from diastasis recti and that I was just slouching (not the first time a woman has been told that her physical issues are the result of laziness). After I explained that I was slouching because I couldn’t hold myself up because my stomach muscles are still an inch apart, she grudgingly agreed to give me a new PT prescription, told me to do 15 minutes of yoga every morning, and then emphatically recommended that I see an expert in cupping that she had visited. I will not be going back to that doctor.

My experience in dealing with diastasis recti seems typical. It’s not an aspect of postpartum recovery that is really emphasized, especially while you are pregnant. And maybe the sexist expectations about female physical strength and body image make it hard for postpartum women to explain why it bothers them.

Which brings me back to Every Mother. What tripped my bullshit alarm was when the ad I was shown equated “stomach pooch” with diastasis recti. The ad was a link to an article advertisement (maybe sponcon?) on Goop (further bullshit alarms ringing), and the description text in the video was the same as the opening lines of the article:

Some call it a pooch. Some call it a mommy tummy. Technically it’s called diastasis recti. It’s a stubborn bulge in the middle of the abdomen that is either a badge of motherhood or the tricky thing about wearing a bikini, depending on your personal feelings about it.

If you are pregnant, have been pregnant in the past, or satisfy enough of the variables that online search algorithms think you are interested in having children, you’ve probably been targeted with content surrounding “stomach pooch”. Stomach pooch is the lower abdominal bulge that often accompanies aging in women, particularly if they’ve been pregnant and had diastasis recti. And as far as I’m concerned, it’s largely a myth. Every time you see a tabloid headline of “BABY BUMP?!!!!” with a big red arrow pointing to some famous woman’s abdomen, you’ve seen everything you need to know about what the stomach pooch means to our society. Young women supposedly don’t have it. Virginity, or at least a virginal body, is associated with a flat stomach. The second you slip into motherhood, your stomach rounds out and you enter into the realm of maternity and unfuckability. The reality is that plenty of women at every stage of life have a roundness to their lower belly, and plenty are flat. Upholding the mythology of this flat virginal stomach is the recurring popularity of shapewear, which fell out of fashion in the women’s revolution of the late-60s and 70s, but has seen a resurgence in a culture both enamored with early-20th century fashion and the wasp-waisted Kardashians. Now, I don’t actually think shapewear is the Devil, nor some form of patriarchically-enforced torture (which of course we feminists consider to be the same thing), I just see it as obscuring the physical reality of women’s bodies.

Manuscript page depicting Christ, the Virgin Mary, and Mary Magdalene. The Met Museum 32.100.474b.

But I’d like to point out that even the famously thin-and-virginal-obsessed Western beauty standard wasn’t always so into the flat belly. Medieval art loved to depict women with rounded stomachs, reflecting pre-modern styles that accentuated this feature. Although when I once pointed this out to a casual art lover, she asked if this was because medieval women were “always pregnant”. No. First of all, even without birth control, it’s actually not that easy for many women to get pregnant, and women who are nursing often cannot get pregnant either, so an era before reliable birth control was not a revolving door of pregnancy. Second, the women depicted this way in medieval art were distinctly not pregnant. Often they were the Virgin Mary, who, though by definition was a mother, was also, by definition, the epitome of virginal beauty. There was no difference in how the stomach of the Virgin Mary was depicted versus her counterpart, Mary Magdalene, who was canonically not a prostitute but perhaps is not historically perceived as a virgin either. For both archetypes of women, the ideal body that medieval illustrators used was the rounded stomach. If we look at the famous illustrations depicting Christine de Pizan, who represented courtly fashion in Renaissance France, we can see that this was simply how women were perceived, perhaps even desired, prior to the popularization of the perfectly flat belly.

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Image detail of Christine de Pizan, The Queen’s Manuscript, c. 1410–1414, f. 290r (Harley MS 4431, British Library), image from https://brewminate.com/christine-de-pizan-and-the-medieval-book-of-the-city-of-ladies/.

And when did that happen? For this one, I’m blaming Queen Elizabeth I, who popularized both performative virginity and a perfectly smooth torso. Elizabeth, like Mary Magdalene, was probably not a virgin in the sense that she didn’t have sex, but instead developed an image as perpetually youthful(ish) to go with her unwillingness to marry. As a result, she was typically not viewed as maternal, but instead as an embodiment of the country of England itself.

c. 1600-1610 portrait of Elizabeth I in her coronation regalia.

So I’m just not going to accept that the mommy pooch exists as such. Instead, I think two things are going on: 1) visual media use the mythology of the mommy pooch to manufacture stories about the bodies of women in the public eye, either to speculate about their pregnancy, obsess about their weight, or enforce a particular standard of beauty; and 2) because of (1), women who have diastasis recti can only discuss it within the public sphere in terms of how it makes them look, rather than how it makes them feel. I will be the first to shit on Goop and their ilk for peddling dangerous nonsense, but their promoting of Every Mother is one of the only widely advertised and available resources for addressing diastasis recti as a real medical issue. The problem with both Goop and Every Mother’s approach, though, is that they still present diastasis recti as primarily an issue of female beauty, rather than female physical comfort and health. For this reason, Every Mother claims that its regimen can fully heal diastasis recti (and return your stomach to its pre-pregnancy flat state), even though there is no real evidence that it can do that. But this is largely what is available to women with diastasis recti today, and so it is bullshit sites like Goop, which continue to have a huge following despite well-publicized and enforced public reprimands, that get to shape how women see the resources available to them.

As for myself, I don’t much care if it’s ever going to be socially acceptable for me to wear a bikini in public again. I wasn’t wearing one too often to begin with. But I’d like to be able to get to the end of the day without having to lie on the floor for an hour. And I’d like to be able to have interactions with strangers about motherhood that don’t include them undressing me with their eyes and telling me that I look like I lost all the baby weight. Diastasis recti is a medical issue, it should be treated like one. And women’s stomachs look how they look, so let’s stop obsessing.