- D.R.A.M is just a fancy word for when your abdominal muscles split and separate during pregnancy.
- You may notice a bulge or 'peaking' vertically along the midline of your abdomen as you attempt to sit up, cough or laugh.
- After the birth of your baby you can do a simple test on yourself to see if your abdominals have separated.
- The separation could be so slight, you may not even notice it has happened, while other women will have a much larger separation that is very obvious.
- There are various factors that may predispose a woman to experiencing a significant abdominal separation.
Pregnancy is a time of massive physical change and adaptation for all expecting women. One HUGE and obvious change that you can expect to see, is your rapidly expanding abdomen. Your growing baby will require more and more room as the months progress. For many women, this results in the splitting (or separation) of one of their abdominal muscles to make enough room for their baby inside. In fancy medical jargon this is called a D.R.A.M. Here you will find out; what exactly a DRAM is, why they happen, what they look like, how to test to see if you have one, who is predisposed to getting one and what you can do to help take care of your tummy while you are pregnant.
What Is A D.R.A.M?
A “D.R.A.M” is a Diastiasis of the Rectus Abdominis Muscle. “Diastasis” means a “separation of” and the “rectus abdominis” is the technical word for your 6 pack muscles in your abdmomen (yes they are in there even if you can't see them!)......so D.R.A.M is just a fancy word for when your abdominal muscles split and separate during pregnancy.
What Causes A DRAM?
Your growing baby who is developing inside you will soon run out of room unless your body adapts. Your pelvis will expand, your ligaments will soften and your abdominal muscles will stretch. For some women even these significant bodily changes are not enough to accommodate their growing baby and more room is required!
The 6 pack muscle (rectus abdominis) is two straps of muscle joined together in the middle by connective tissue (linea alba). As your baby applies pressure on your body for more room to grow, the rectus abdominis will stretch as far as it can....but when it can stretch no further, the two straps of the muscle will separate down the middle (along the linea alba). This allows these separate straps to take a “short cut” and travel a shorter path around the sides of your pregnant belly, rather than having to stretch all the way over the top. This allows your belly to grow further out in front and provide more room for your baby.
What You May Notice If You Have a D.R.A.M....
(1) During Pregnancy
- As your belly expands further (after about 6-7 months if it is your first pregnancy) you may notice a bulge or 'peaking' vertically along the midline of your your abdomen as you attempt to sit up from a lying down position, cough or laugh.
- You may also feel pain and discomfort around your belly button or the midline of your abdomen
(2) After Childbirth
- You may notice the same bulge or 'peaking' vertically along the midline of your abdomen as you attempt to sit up, cough or laugh.
- Your abdomen may look like a very slack and loose “pot-belly” that you have very little control over.
- You may be experiencing back pain due to reduced abdominal support for your lower back.
Routine Postnatal Check for DRAM
Do not do this check if you are still pregnant. This check is designed only for women who have already given birth.
If you have had a caesarean and your scar is very painful, it is advised not to do this testing proceedure until your pain has reduced significantly. If you have had a vaginal birth, this testing proceedure may place extra strain on your pelvic floor, so do not proceed if you are feeling excessive pain or discomfort in your pelvic floor or low back area. If you are in doubt at any time, please consult a womens health physiotherapist to be assessed professionally. If you feel you can manage a half situp action without excessve pain or discomfort, then you may proceed, however always move gently and slowly and stop if you are in any pain.
Lie on your back and place one finger 1-2 cm above your belly button in the midline of your abdomen where the two sides of your 6 pack muscle meet in the middle. Press down into your abdomen with moderate pressure as you gently lift your head and shoulders up off the ground. You should feel the two straps of your 6 pack muscle close in around your finger as you sit up. If you don't feel this, lie back down again and place two fingers side by side in the middle this time. Repeat the half situp action to see if you can feel the edges of your 6 pack muscle closing in on your fingers. If you still can't feel anything around your fingers, repeat with 3 and then 4 fingers side by side in the middle of your tummy as explained above.
Try to do this testing proceedure as few times as possible as it places significant pressure on your abdominal wall, pelvic floor and lower back. If you still can't feel anything with 4 fingers in the middle of your tummy it is advised you attend an appointment with a women's health physiotherapist to be assessed professionally.
Results Of The Postnatal D.R.A.M Test
No gap = no abdominal muscle separation
1-2 finger gap = minimal abdominal muscle separation which is likely to improve over the first 3-6 months postnatally, with a good chance of returning close to it's pre-pregnancy position
3-4 finger gap = significant abdominal muscle separation which is likely to improve over the first 3-6 months postnatally, but may not return completely to it's pre-pregnancy position
Who Is More Likely To Get A DRAM?
Most women will experience some extent of abdominal separation during pregnancy, however there is a large variation in the size of separation that women experience.
- strong, tight rectus abdominis muscle (6 pack) prior to pregnancy
- doing situps (or other high load abdominal work) during pregnancy
- multiple pregnancy (twins or triplets)
- genetic factors including tighter or less 'stretchy' collagen and connective tissue
- if your baby is over 4 kg at birth
-if you had a separation in a previous pregnancy
- if you are short or have a shorter trunk (small distance between your pelvis and ribs)
Can You Prevent It?
Unfortunately you have very little control over most predisposing factors listed above. However, it is advised that ALL women avoid doing situps and other high load abdominal exercises and activities for the duration of their pregnancy. It is very important to keep your abdominal muscle group strong during pregnancy, but this must be done in a safe and more effective manner by focusing on strengthening your deep core stabilising muscle called your tranversus abdominis. For further information on this please read “How To Activate Your Core Stabilising Muscle” here at Skillforkids.com.
Getting in and out of bed correctly is also an important technique to learn while pregnant to help reduce unnecessary strain on your abdominal muscles. As soon as your abdomen begins to grow, you should start getting out of bed by rolling on your side and pushing up with your arms. Check this video out to see how it is done.
If you have found that you have a D.R.A.M please read What To Do If You Have A Separation of Your Tummy Muscles here at Skillforkids.com.