The Abdominal Wall After Delivery

When choosing exercises after delivery, most new mothers think of achieving a flat abdomen as their first priority. Actually, the pelvic floor should receive prime attention with the abdominal muscles second. Strong pelvic floor muscles ensure good support of internal organs and sphincter control (urethra, rectum, and vagina). They also ensure pleasurable sensations during sexual intercourse for both the woman and her partner.

After vaginal delivery, the pelvic floor may be bruised, swollen, and tender. After a cesarean section, it may be lax. In either case, the pelvic floor loses tone or elasticity from the weight of the baby and months of sluggish circulation.

You may be surprised at your initial attempts to tighten the muscles of the pelvic floor immediately after delivery -- you feel little or nothing! Your muscles have been torn or cut and nerves, damaged. It's no wonder you have little sensation. Perhaps, too, the structure of the pelvic floor was surgically repaired.

Exercise can improve all these situations by 1) alleviating discomfort (although it is uncomfortable at first to even gently squeeze those muscles) and 2) improving circulation to the area, which increases the oxygen supply, removes waste products, decreases swelling, and promotes the prompt return of urinary control.

If you neglect the pelvic floor area, the muscles remain stretched and loose. They become further weakened as you resume your usual schedule. The sooner you start to exercise the pelvic floor after delivery, the faster the muscles respond. Waiting only results in more time and effort necessary to strengthen these muscles.

The Abdonimal Wall

Right after delivery, you may wonder if your stomach will ever be flat again. If you begin an exercise program early (within 24 hours of giving birth) and are fiercely persistent with frequent repetitions of the appropriate exercises, your stomach will indeed be flat once more.


The abdominal muscles we feel and notice most often are the rectus muscles. They are long, slender muscles located along the center of the abdominal wall. They run vertically from the end of the sternum (breastbone) and the lower ribs to the pubic bone. The right and left rectus muscles are separated by a band of fibrous connective tissue about 1/2-inch wide called the linea alba.

The internal and external oblique muscles lie on the sides of the rectus muscles. They cover the waist -- a hard area to tighten even when you haven't had a baby. The external obliques cover the front and sides of the abdomen from the rectus muscle to the back muscles. The external oblique muscles have a wide area of attachment: The top edges attach to the ribs, and they run from the lower eight ribs to the front surface of the pelvis and on down to the pubic bone.

The internal obliques are directly below the external obliques. Most of their muscle fibers are nearly horizontal, running at almost a 90-degree angle to those of the external obliques. The internal obliques run from approximately the waist area down to the pubic bone.

All this may sound unnecessarily technical when you just want to have a flat belly again, but knowing how your body is put together enables you to understand how the exercises work and what kinds of exercises you need to renovate those muscles after delivery. Learning to listen to your body is also a primary step in getting started.

The lower ends of the rectus muscles go through a slit in the deep abdominal muscles before they attach to the pubic bone. When the rectus muscles are relaxed, as they are when you walk and move around, they follow a curved line; they become straight only when they contract (when you consciously and tightly hold in your stomach).

Hereditary factors come into play in the deposition of fat in the lower abdomen, even when body fat is at an ideal level. Because the rectus muscles are curved and small deposits of fat are stubbornly held in that area, most women find their stomach is still slightly rounded.