In Canada, roughly one out of four women will give birth through their belly, also known as a cesarean birth. However most people don’t talk about some of the unique healing challenges that women face after a cesarean birth. Not being able to lift, and being sent home with ababy and carseat to carry around. The pain that comes with trying to stand upright with a healing incision. Possible complications with healing. Difficulties breastfeeding. Then when you have healed, the strange disconnect between your brain and the muscles of your abdomen. Where there was once strength now there is a weak feeling, and it’s hard to get the abs to activate how they once did.
For some women their c-section car can cause lingering pain and discomfort. Here are some common ones that I see:
– Tugging or pulling in the area of the scar or deep underneath, especially with certain movements
– Tightness in fascia and muscle tissue in the area beneath the scar and above the pubic bone (Insert picture?)
– Pelvic floor problems
– Numbness around the scar tissue
– Painful period cramps when previously there wasn’t an issue
– Low back pain and weakness in the core
– Inability to activate certain core muscles, especially the muscle fibers below the incision site
– In a small portion of women unexplained difficulty conceiving
Cesarean scar treatment with massage therapy
Massage therapy is a hand on way to address some of these issues. When I asses a client coming into my office we go over several things. How old is the scar tissue, and how long have the problems been present? Are there any other symptoms going on with the low back and pelvis or pelvic floor? Was it a planned cesarean/repeat cesarean birth or an emergency? Were there any complications with healing? These all help me build a picture of what the person may be experiencing and why.
The Treatment
While some treatment plans may vary based on the person’s needs, they will all include abdominal massage and work on the scar itself. Treatments generally start out with work on the low back and hip muscles to assess the pelvis, and then move to working on the abdomen.
I do very gentle work with cesarean scars. There are several reasons for this. Cesarean scars are unique because organs lie underneath them. The intestines, bladder, and uterus can all be affected by excessive scar tissue. During the healing process, the body lays down scar tissue and sometimes this can form adhesions or attachments to these surrounding tissues. Sometimes the uterus can become tilted and pulled forward or backwards due to these connections. Another complication of cesarean birth can be the bladder gets nicked during the surgical procedure as well, which would form additional scar tissue.
Because there are so many important organs in this area I focus on making scar tissue more elastic and pliable. I bring better blood flow to the area with gently scar work and massage techniques. I want the scar tissue to be able to move with the natural motions of the organs with less tugging and pulling. Scar tissue from surgical procedures is actually a very important structure for healing, so we don’t want to try and ‘get rid’ of it. Instead we want that scar tissue to work fluidly with the layers of connective tissue without catching or pulling, seamlessly becoming just another structure of our body.
First the abdomen is warmed up through general massage work. Then I ask my client to find their scar underneath the sheets. Because these scars can be very low on the abdomen, often past the underwear line, some people are more comfortable working over the sheets on it, while others don’t mind direct hands on work in this area. This choice is completely up to you, as I can work both ways.
During treatments I explain how I am assessing the different movements of the scar tissue. I look for directions that feel tighter than others, and to see if certain motions create the tugging or pulling. I can also look at the scar to see if it is higher on one side, or has healed better on one side. I then show women how to self massage the area at home, and techniques that they can do gently to help the area. These may vary from person to person. Sometimes it’s just one treatment, while others it may take several to see results. We also then work on muscle activation below the scar in order for clients to feel with their hands what coordinating certain movements is like and what the difference between different muscles feels like.
Emotional responses to cesarean work
Because birth is a huge transformative part of a persons life, some people can have trauma around their cesarean birth and scar. Sometimes this means that it can be hard for a person to look at their scar, touch it, or want to massage it. Sometimes working on the scar can bring up memories of the birth, or feelings associated with it. Others may fee disconnected from their body, and that their scar isn’t a part of them, or are having difficulty with how their body looks and feels after their experience. These feelings are all normal, and we work within your comfort zone during your treatments. Some people are only okay just getting used to someone touching their scar or demonstrating a homecare technique, so the treatment and hands on portion is very short. Others may be surprised by an emotional reaction when they thought they would be fine, which can bring up tears or fear. In this case we stop treatment and continue only when the person is ready, either focusing on a different area or stopping all together. It’s important to know that you have control of your treatment and what happens next, as well as feel safe.
I hope that this blog has helped you understand how I treat cesarean scars, and how massage therapy can be helpful to you!
Alyssa Green is a Registered Massage Therapist, doula, mentor, and Co-Owner of More to Life Massage Therapy. She is passionate about treating the pelvis and low back, as well as experienced in pregnancy and postpartum massage. She loves helping others learn more about themselves, especially when it comes to the reproductive system.