Four years after my youngest child was born, I lay on an exam table while a doctor pressed his fingers into the space that had formed between my abdominal muscles. He told me to do small crunches. He measured the width and depth of the space and called it severe. When I did a full situp, he had me pause at the top and said, “Wow, look at that coning!” as if the strange dome that my stomach became when I engaged my abs was a roadside attraction.
He asked me about my fitness routine. I told him, proudly, that I regularly made it to at least three power-lifting classes per week and was on my way to becoming an instructor.
“You could do a million ab exercises,” the doctor told me. “You could be the most fit person on the planet. It wouldn’t change a thing.”
I’d known for years that I had diastasis recti, which happens naturally in the third trimester of pregnancy when the abdominal muscles separate and move to the side of a pregnant person’s body to make room for a fetus.
For 45–60% of postpartum women, the muscles fail to return to the center and seal correctly after birth. One study showed that 30% of women have mild abdominal separation for up to 30 years postpartum, while 10% have a long-lasting, more severe separation, and I was one of them.
My main symptom was back pain. Over time, diastasis recti can cause incontinence, overall weakness and hernias.
The doctor told me that surgery was the only thing that could fix it; specifically, an abdominoplasty, or tummy tuck. But insurance wouldn’t cover it because it was considered “cosmetic.”
Dr. Frank Agullo, a plastic surgeon in Texas, told me that even though diastasis recti and loose skin can have major impacts on a person’s daily living activities, “like carrying their children or sleeping through the night,” insurance companies call it cosmetic because there is no imminent medical danger.
“The fascia is intact, nothing is pushing through. The muscles have just separated, and the belly bulges out like a hump. Repairing it improves back pain, posture, core strength and urinary incontinence in many of my postpartum patients,” he said. “So the insurance companies ignore all those health impacts, focusing only on the flattening and contour of the tummy.”
“If I don’t have the money, I just have to live like this?” I asked my doctor.
The doctor nodded apologetically and shrugged.
As soon as I left, I booked a consultation with a plastic surgeon.
I’d already been considering a tummy tuck for years because my first two pregnancies left me with loose skin on my abdomen that felt sensitive and thin. For the last half of my 20s, I wore the style of high-waisted, soft, stretchy pants I’d rocked in third grade to reduce direct pressure on my midsection. In the summer, a heat rash formed if a band of fabric pressed against my extra skin. Sundresses became my whole vibe until the season changed.
With the skin problem alone, I was perpetually uncomfortable but too afraid to commit to going under the knife. Plastic surgery is safer than it used to be, but abdominoplasty has a higher rate of mortality than operations like breast implants or facelifts. I’d endured the sudden death of my father when I was 15, and I didn’t want to do anything that might risk putting my kids through the nightmare of losing a parent during childhood.
But after my last birth, the back pain was relentless, and my core weakness impacted every area of my life. I upped my workout schedule, assuming I needed to be more intentional about building muscle. It helped my confidence, but the center of my body continued to ache and feel wobbly.
Eventually, I slipped a disk while lifting my older child. I gritted my teeth through the pain, meal-planning and all the regular domestic work required to keep a family safe and running. I also worked full-time as a speech pathologist in an elementary school, and my job required me to be quick on my feet. Month by month, I felt increasingly worse.
Then, the state of my body started to affect my mood. I didn’t feel as peppy or playful, and that wasn’t fair to my kids. “The way my back and core feel hijacks my attention,” I told my plastic surgeon. “It’s making me a bad mom.”
He patted me on the back of the hand and listened to my litany of fears about anesthesia and recovery. He described the procedure in thorough detail, his voice gentle. I didn’t feel pressured, and I was grateful that I needed to save up for the surgery. It would give me time to sit with the risks, rewards and financial cost of the decision.
I finally went for it when I’d set aside enough cash to pay for the procedure up front, completely worn out from trying to manage the constant discomfort. I didn’t feel like myself, and after consulting with multiple specialists, an out-of-pocket tummy tuck was truly the only option.
“It’s almost like building a corset inside your body,” said Dr. Shim Ching, a plastic surgeon in Hawaii. “We’re essentially making a low, horizontal incision, lifting up the skin, exposing the muscles, and I go in and tie them together,” Dr. Ching said. “We can repair those muscles back to where they should be.” He explained that there are no other options that address both the skin and the muscles in a functional way.
The day of my pre-op appointment, the plastic surgeon drew on my abdomen with a purple marker, showing the skin he’d remove. “We’ll have to take off your belly button,” he said.
My mouth dropped open. He handed me a book of belly buttons that he’d designed for his previous patients, photographed at various stages of the healing process. “Time to go shopping,” he said.
Throughout the experience, I had cared very little about the aesthetics. My first pregnancy brought me thousands of stretch marks, and a tummy tuck came with an enormous scar, hip-to-hip. I knew I’d never look like I was 20 again, and I didn’t want to. Other than the sensitive skin and core issue, I liked how pregnancy had changed my body.
But now I had to think about what I wanted my belly to look like. I touched the pictures of the belly buttons and told the doctor I had no idea. “I suggest a soft oval,” he said, flipping until he found a healed, ovular image. He tapped it. “Very popular.”
“Soft oval it is,” I said, shutting the book. The next morning, I arrived an hour before surgery so he could redraw his purple lines. I put my hair in a bun, shoved it into a sterile shower cap, and changed into a robe, flimsy paper underwear, grip socks. A nurse led me into the surgical suite, helped me climb onto a table shaped like a lowercase “t”, arms out. She placed a heated, plastic blanket over my body, inserted an IV, covered my mouth with a mask, and I was out.
When I woke up, my left shoulder hurt more than anything else. “The gas we use irritates a nerve that’s connected to your shoulder,” the recovery nurse told me. Nothing she gave me dulled the unexpected shock of pain. I felt vulnerable, regretting that I’d paid someone to chop my body into pieces and sew it back together, but I didn’t break down until it took three tries to slip on my sandals. “You built three brand-new human beings,” the nurse said, rubbing my back. “It tore you up. Now you get to heal, for real.”
“In my youth, I knew little about plastic surgery, thinking it was indulgent at best. After going through it, I believe it should be offered to people with birth injuries by default.”
My shoulder pain abated within hours. The doctor had threaded localized painkillers throughout my abdominal muscles, so even though I walked with a hunch, the pain in my abdomen was mild for three days, only moderately sore after. It took about six months for me to stand fully straight. My only complication was a wicked bout of COVID a few weeks after surgery that I thought would split me in half. “Hold a pillow against your tummy when you cough. You’ll be fine!” the on-call nurse said in the middle of the night, and she was right.
In my youth, I knew little about plastic surgery, thinking it was indulgent at best. After going through it, I believe it should be offered to people with birth injuries by default. Research has shown for years that the emphasis on beauty for U.S. women creates mental health issues, gaps in career potential and plenty of other medical problems. Even if abdominoplasties really did only address repairing physical damage to a woman’s appearance from childbirth, in a country like ours, providing them postpartum seems like ethical healthcare.
But the pain and discomfort after carrying and delivering a baby are real medical diagnoses. Insurance companies will prescribe pain killers for decades to treat the back problems that are caused by diastasis recti, for example, but not pay to repair the separation itself.
It’s been five years since I hobbled out of that recovery room, terrified that I’d made a selfish and risky choice. Now, I believe going through with the surgery is one of the best decisions I ever made. As I recovered, I realized how much my separated abs had impacted my overall posture and comfort with even leisurely activities like going on a walk. Surgery and recovery were a huge ordeal, but I did feel better and stronger every week. My lower back pain is over, and my core feels solid.
Without the constant haunt of discomfort, I’ve been a far more present mother. I take my kids on vacation at least once a year and lift my daughter in and out of theme park rides without a problem.
The bonus, of course, is my ovular belly button. I never really looked at that part of my body before, but I kind of love it now. When I notice it in the mirror, it reminds me that sometimes it’s worth taking a taboo risk that feels right for your body, even if people might judge you for it.
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