Massage, Bodywork, and the Cesarean Section

I am thrilled to be presenting at this months International Cesarean Awareness Network meeting on August 12 at 630 pm in Minneapolis.  The meeting will take place at Holy Cross Lutheran Church, 1720 E. Minnehaha Pkwy, Minneapolis, MN.  I will be talking about the benefits of massage and bodywork in preventing a c-section and also what can be done after a c-section.  Today I am going to give a little over view of what will be talked about and what we will be doing on the fine Monday evening.

The Cesarean Section and the Woman's Body

When women are asked (and often not asked) to undergo c-section it is rarely explained to them that the procedure is major abdominal surgery.  It is rarely explained to them that the scar tissue is not only superficial in the skin but can potentially form deeply into the abdominal and pelvic cavities.  Too often women are not fully informed about this everyday surgery that is performed, sometimes unnecessarily, sometimes lifesaving, and what the long term ramifications will be in their lives.  Surgeons are not leaving out soft tissue information out of malice or even ignorance - simply because they don't think about it.  Traditionally trained medical doctors in the United States rarely consider that scar tissue lays itself down in a random pattern, nor do they think about how this random pattern will effect the function of muscle, tendon, ligament, bone, and organs that are near the scar tissue.  There main concern is keeping everyone alive.  Now that being said, I have met a handful of fantastic surgeons that do indeed think about these things are very careful about when and why they cut and whether or not they are cutting into previously formed scar tissue.  So please, understand I am talking about surgeons that slice and dice to get their share, and I truly feel this breed of surgeon is becoming more rare.  I guess I'm an optimist.

The Scar

There are many different shapes, sizes, and thicknesses of scars.  My own mother has a "zipper" scar from her pubis up to her navel from two c-sections.  It has caused her physical, emotional, and spiritual pain for many years.  I have also seen the tiniest, faintest scars just above the bikini line that never caused a days discomfort.  I give you these two extreme examples to show that there is a broad spectrum of what the scar can manifest in women.  Let's talk about the physical scar.

Scar tissue is the body's way of quickly healing itself when there has been a violation to the skin or deeper tissues.  When scar tissue forms it does so in a random pattern.  It is not striated like muscle tissue, nor does it have a predictable pattern.

The above is an image produced by BodyScientific International.  You are looking at a micrograph of the random  pattern that scar tissue creates within the soft tissues.  When this random pattern is mixed with the predictable patterns of non-damaged tissue in the body a few different things happen.

• Reduced Range of Motion (ROM)
• Possible Pain with Motion
• Possibility of Micro-Tears forming in the surrounding tissue

In the past manual therapists have been taught to apply deep cross fiber friction for several minutes over the scar tissue fibers with the claim that this alone will realign the tissue.  I personally have never found this to do much other than cause inflammation and pain.  I was fortunate in my quest immediately after graduating from massage school that I found James Waslaski.  The following three years I devoted my study to his techniques and learned from him that scar tissue requires multidirectional friction to address the random pattern of lie in the tissue followed by pain free movement and eccentric contraction of the muscle the scar tissue is present in.  Waslaski has revolutionized the field of massage therapy with this gem of a technique.  The really cool part that has not been explored, at least to my knowledge, is that even when the scar is present in organs, which are involuntary muscles (that means we do not consciously control their movement), the organs will contract with the scar tissue having been realigned in the soft tissue surrounding itself and hopefully take the hint and realign the tissue within itself with the automatic contractions that organs go through every minute of every day.  Part of the reason I believe this is possible is because of the fascia.

The Fascia

Fascia is a delicate yet strong fibrous net that runs throughout the human body.  It is helps maintain the form of soft structures, create lubrication between those structures, and when it is injured is plays a big role in letting us know that there is damage to an area.  The fascia connects and separates simultaneously because of its nature.  When there is a scar in the area the fascia is compromised by reduced blood flow and having its net structure disrupted.  Recently, scientists have discovered that fascia carries nerve receptors that communicate pain to the body (nociceptors) (Tersarz, et. al. 2009) and it contains contractile fibers (Schleip, et. al. 2007).  When the soft tissue is damaged by a cut so is the fascia.  Fascia surrounds our fat cells just below the skin, surrounds the muscle, tendons, organs, ligaments, separates the cavities of the body, and then it is also present microscopically gently supporting each fibril of muscle, each whisp of periosteum.  So you can see that when the body is cut, this dynamic web that helps to hold us together can get damaged and cause great pain not only in the area where visible damage is, but it can also cause pain in areas that may completely mystify you.  Think about what happens when you pull one strand from a spider web.  The web folds in on itself and those intricate patterns are changed.  It is the same concept with the fascia when it is cut or damaged.  The damage will reverberate throughout the body.  The following is one of my favorite youtube videos of the fascia.  It shows the net/web of fascia magnified 25x and explains what you are looking at.  It will help you understand how interconnected the tissues are in the human body.

The Recovery

Recovery from a c-section is as different for every woman as birth is.  No one is the same but everyone shares the common bond of the incision.  It is important to keep in mind that soft tissue has a memory.  Every event of your life is stored in your body.  Sometimes our mind remembers it and sometimes an event has to be stored elsewhere until we are strong enough, ready enough, sure enough to let it out, let it go, and accept the event for what it brings to our life experience.  Christine Courtois, Ph.D., states that  "Although the victim may make a psychological escape, the body is left 'holding the bag,' so to speak."  She is specifically speaking of sexual abuse victims in this quote but the statement has been found to be true for all types of trauma to the body.  The next point I would like to make about recovery is that it si a continuous journey.  As our body travels towards optimal health and rebalances itself, leaving us feeling great for a time and then suddenly we will fall back again, to need another guiding hadn to move us farther along our journey to health, whole health.  Working with several practitioners in various fields can help speed the recovery from an unwanted c-section.

Prevention of Cesarean Section with Massage and Bodywork

Before I begin this section I want to make it clear that not all c-sections are preventable.  Circumstances will arise that necessitate the intervention of a c-section.  Barring those circumstances, this is what you can do to try and prevent a cesarean section.  
First, get a doula.  Simply having a doula present at your birth lowers the incidence and need for interventions (Hodnett, et. al. 2011).   Better yet, find a doula that has Spinning Babies training.  You cannot start too early using the techniques that are found at Spinning Babies.  They help you learn to use Balance, Gravity, and Movement to get your body ready for the big day.  
If you are having pain, discomfort, or difficulty moving find a practitioner in a modality you are comfortable with, that you trust, to help you resolve those issues.  Again, the sooner you begin addressing those issues, the better.  Who are these practitioners?

• Chiropractors
• Acupuncturists
• Physical Therapists
• CranioSacral Therapists
• Massage Therapists
• and many more....

Ask your friends who they like and go from there. 
Why shouldn't I just grin and bear the discomfort?  Why spend the money?  Well, having your body balanced before you are late in your pregnancy and it is more challenging to redirect soft tissue will make your pregnancy more comfortable, your labor potentially easier, and potentially reduce your risk of cesarean section.  
Next, regular, fun, enjoyable exercise.  Whatever you conceive that to be, that is what you need to do everyday.  Maintain your strength, increase your endurance, but most of all - have FUN while you exercise!  It is good for you and the baby.  
And of course all of the other goodies your prenatal provider advises for you - good nutrition, restorative rest, regular check-ins with said provider.  

Communication, Collaboration, and Integration

To take a genuinely holistic approach to the healing process it is important to be open with the people you employ to guide through your healing journey.  And yes, I mean your medical doctors too.  Everyone needs to be on board with what is right for your experience.  You have the right to get good information on the B.R.A.I.N.N. of your course of treatment.  What is B.R.A.I.N.N.?

• What are the Benefits of this treatment?
• What are the Risks of this treatment?
• What are the Alternatives to this treatment?
• What does my Intuition tell me about this treatment?
• What happens Next if I proceed with this treatment?
• What happens if I do Nothing?

I first learned of the acronym from the Childbirth Collective in Minnesota.  I have found it to be useful not only in birthing situations but in any situation.  This is where your Communication begins with your providers.  It is your responsibility to get the information, learn it, and make a sound decision about your care for recovery.  Once your have taken those steps ask your providers to Collaborate.  This opens Communication between disciplines and will make the road to recovery easier for you.  And finally, Integration - don't be afraid to tell your general practitioner that you went to see a Reiki Master, or a Reflexologist, or a spiritual helper.  Everyone involved in the recovery process needs to understand that the scar you carry goes deeper than the tissue.  Everyone involved will step up and follow the course of Communication, Collaboration, and Integration if they are allowed.  You get to be the CEO of your care for your scar.  Everyone else is just a guide to remind your body, mind, and spirit where it wants to go to recover from the scar.

I hope you can join us Monday the 12th for a live version of this post.  I will also be demonstrating and teaching some self-care techniques for those who have scars that are uncomfortable.  

Rebalance, Renew, Rebloom
Adrienne


Source List:

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth (Review). The Cochrane Library, 2011, Issue 2, p. 13, 57

Schleip R, Klingler W, Lehmann-Horn F 2007 Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanics. In: Findley TW, Schleip R (eds.) 2007 Fascia research – basic science and implications for conventional and complementary health care. Elsevier GmbH, Munich, p.76-77

Timms, Robert, Connors, Patrick, Embodying Healing: Integrating Bodywork and Psychotherapy in Recovery from Childhood Sexual Abuse.  Brandon, VT: Safer Society Press; 1992. p. ix.

Tesarz J 2009 The innervation of the fascia thoracolumbalis. In: Huijing PA, Hollander P, Findley TW, Schleip R (eds.) 2009 Fascia research II – basic science and implications for conventional and complementary health care. Elsevier GmbH, Munich, p.37