Massage After Cesarean Section Birth

Cesareans can save the lives of mothers and babies; however, the reality is that a cesarean is a major surgery.  It is possible for a full recovery.  Postpartum healing and recovery can be aided by receiving regular postpartum massage.  During any kind of surgery, in this case surgical birth, a mother’s body will register a gamut of feelings and emotions that will need to be addressed later during her healing.

Release Adhesions With Massage
 
The Women’s Surgery Group, along with other groups of research findings estimate that adhesion formation is extremely common in post-surgical patients.  In 55 to 100% of patients who have gynecological surgery involving the uterus, fallopian tubes, or ovaries (including cesearean section), adhesion healing difficulty is common.  In a cesarean surgery other issues may also occur such as extended healing time, chronic pain, pain during intercourse, bowel obstruction and even occasionally infertility. Repeat cesareans have an even greater occurrence of adhesion formation.
 
It is required occasionally, additional surgery is required following the formation of adhesion scars.  Sometimes chronic pain is established after a surgery; this could indicate scar tissue adhesions from surgery.  Adhesions are bands of scar tissue that can distort anatomy and bring organs and tissues into abnormal locations causing discomfort.  Adhesions can be indicated when external scars appear.  Tissues can look puckered, or uneven as the top layer of skin is pulled down into deeper tissue layers.
 
Surgery for "lysis of adhesions," or removal is performed resulting in 303,000 hospitalizations at $1.3 billion spent annually.  Adhesions can actually reform after this kind of surgery, and they can reoccur 80% of the time, simply as a reaction the surgery meant to release them.  Instead of surgery, certain massage techniques such as neuromuscular therapy, deep tissue sculpting and postpartum therapies limit the formation of adhesions and scar tissue in new injuries, and often reduce existing scar tissue to make it more pliable at old injury sites; thus reducing the need for a second surgery for repair.
 
The Emotional Scars of Surgery
 
During the actual surgery, the body registers physical pain in her body, and in her spirit and unconscious memory.  Following the surgery, regardless of whether it is a planned surgical delivery, or an emergency, the mother usually feels a sense of loss at not having had a vaginal birth.  Additionally, especially in the event of an emergency or unexpected cesarean birth, she could feel a sense of being violated.  When this occurs, the body reacts by trying to protect itself from further injury with involuntary muscle contractions, and tension in the injured area.  When this newly established "body guard" is established, unconscious muscle tension and secondary pain may even outlast the original cause.
 
During and after surgery, physical damage reports flood the nervous system.  Even while anesthetized, a patient’s heart rate and/or blood pressure respond to surgery.  Unconscious psychological controls can be activated, potentially producing anxiety, jumpiness a lowered pain threshold, even a subconscious feeling of betrayal and anger at the experience and those people involved.  Emotions may not be rational, but are valid.  Long after the scars are healed, a woman who has had a cesarean may feel overwhelmed, by details and obligations; she may distance herself from other people, from herself, or from her experience.  She may not be aware of, or allow herself to feel her emotions, instead, storing them in her body.  Her life continues, she cares for baby, and if she doesn’t address or process this experience, she may not get the emotional healing she needs.
 
A massage therapist can provide a place for her to feel safe enough to release both the stored emotions, and the muscle contractions her body is using to protect itself.  She may continue to guard both physically and emotionally the areas where pain has lodged itself.  Massage therapy can be empowering, involving more than just the physical body, but helping to reconnect the brain’s emotional centers.  As a client becomes aware of the feelings stored in their body.  She can use this awareness in the healing process.  Once those feelings are acknowledged, instead of blocking them, or guarding, she can guide their release.  The more deeply hidden the issues are, the more difficult they are to resolve.  If a woman hasn’t dealt with them by the next labor, she will likely have to deal with them in the middle of it.
 
Complete physical and emotional healing is possible for the client who seeks appropriate care.  Releasing deeply ingrained emotions may require the additional help of a psychological counselor.  But for a woman who would like to pursue a VBAC or TOLAC, this emotional release is a vital part of the pursuit of complete healing; physical and emotional; from adhesions causing chronic pain and infertility.  It is imperative that the deeper scars that follow surgery be healed.

 

 
When can a massage begin after surgery is done?
 
Use of very delicate massage and thermal therapy, first using body heat from the hands, helps by increasing circulation.  This kind of massage discourages the new formation of scars and adhesions, and encourages tissues that are swollen with excess fluid to drain.  The body can then re-establish normal lymphatic flow, thus encouraging the body’s healing immune system to work more efficiently.  The client can also aid this process on their own at home by doing gentle, circular strokes on their abdomen in a clockwise direction.  This will aid the abdominal organs to regain their normal functions.  .

 

 
As a Therapeutic Massage Therapist with specialization training with Prenatal and Postpartum mothers, I will work with a woman 24-hours after delivery, and/or as soon as a client’s provider approves, massage can be received.  Also, massage can be received within 24 hours if a mother had a vaginal birth with no complications.  If a cesarean birth has occurred, a mother must give a written release from their provider authorizing massage therapy, before a 6-week follow-up visit.
 
About two weeks after surgery, gentle vibration of the skin over the incision can be used, progressing to deeper pressure as healing occurs.  This will stimulate re-connection of nerves and a reduction numbness due to healing nerve connections.  At 6-weeks post-surgery, tissues can also be gently stretched to encourage greater movement and loosen existing adhesions.  Trigger points in the abdomen (irritable spots) that can make the muscles prone to spasm, should be located and loosened.
 
More Than Just a Rub
 
As an experienced doula, massage therapist, and student midwife,I have observed that labors following a previous cesarean delivery are greatly influenced by old thoughts and emotional experiences from the previous birth, especially if they aren’t actively processed beforehand.  It is important for the mother, her baby, and her family to explore the more deeply hidden issues that need to be resolved before the next birth.  Complete healing is possible if a client allows herself to seek and accept appropriate care.  As a massage worker, I can provide one of the safe places for her to develop awareness of her body and muscles, including those affected by emotional memory.  I can help her to process her surgery through massage, and re-connect with her body and emotions.
 
Resources:
 
1.  Women’s Surgery Group, "Adhesions.  Available at www.womenssurgerygroup.com/conditions/adhesions/overview.asp (accessed July 2010).
2.  N. F. Ray et al., "Abdominal Adhesiolysis:  Inpatient Care and Expenditures in the United States in 1994," Journal of the American College of Surgeons 186, no. 1 (1998): 1-9.
3.  Cook, M. Healing Inside and Out:  Massage for the Cesarean Section Client.  Originally published in Massage Bodywork Magazine, September/October 2010.  Associated Bodywork and Massage Professionals.  Massage Therapy website recovered 10/13/2017. http://www.massagetherapy.com/articles/index.php/article_id/1969/Healing-Inside-and-Out.
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