Cesarean Scar Massage

In honour of Cesarean awareness month, I want to bring up something that is still not widely knows or talked about: Scar massage.

I have a fair bit of beef with how postpartum care is handled here in Canada. I have an extra big beef with how it is handled in response to cesarean births. If one had any other major surgery, one would have several follow-up appointments, probably instructions on care and a suggestion for physiotherapy and long term suggestions/expectations. After a c-section, There are no extra appointments aside from the regular postpartum ones. After 6 weeks, you get to go about your business as if it had never happened as long as there is no infection and the incision is closed. Aside from being told not to get pregnant again too soon, many don't know what is considered normal healing (this goes for vaginal birth too but today is all about cesarean care).

After the initial healing of tissues (those first 6 weeks), scars go through many changes before they are completely settled and healed. This can take months. I usually offer a year as an average. This is the reason for advising no pregnancies for at least a year post partum though many care providers advise none for 18 months. A part of this healing process is a ratcheting down after all the scar tissue is laid. Think of it as a net or tarp that you need to fasten over a load in a truck. You lay it out on top of everything all loosey-goosey and then ratchet it down to make sure it holds tight and nothing moves around. Another thing to keep in mind is that scar tissue is non-discriminatory. This means that it will attach to anything in the area. It isn't going to just lay down nicely where the incision is made even though that is what we would like, it can spread out to the bowels, bladder, pelvic floor muscles etc. Like the tarp can't fasten to the object you are trying to hold down, you have to attach to the truck bed; an outside anchor. When you are cutting through 7 layers of tissue to get through the uterus to the baby, you are setting off the healing system to lay down this scar tissue in each of those layers. And then they ratchet down. By this point, I am guessing you can imagine now why you may be feeling all those tugging sensations inside from your scar, it may feel thick, or why your incontinence issues just won't resolve, or that nagging back pain won't go away.

Now, I am not saying all of this is only due to your scar. You did just carry and birth a baby so your body has been through so much! What I am saying is that our care providers are being negligent in not telling you how to take care of yourself after all of this and your scar is a piece of that puzzle in your new body. You don't have to just accept those nagging annoyances for years to come.

This is where I come in. If you are having tugging that just won't go away, you could likely benefit from scar massage. There is a lot of misinformation in the language used around this topic so I want to be especially clear. I am not going to be "remodeling" "stretching" or "eliminating" the scar tissue. It is far too tough a substance for my hands to do boo about that. Really though, would we want our scar tissue so easily manipulated and changed? It wouldn't be very good at its job if it were. What I can do is teach you how to manipulate the scar tissue to feel more flexible and pliable so that it doesn't tug so much. We often use the term "releasing" because that it what it feels like though I am not literally changing the scar tissue (I can't do that). By teaching you how to do it, I am hoping to also encourage you to re-connect with that part of your body. For some, their scar is a reminder of birth trauma and taking time to learn how to touch it lovingly and with care may support that healing. Many report long lasting numbness in the area and manipulating the tissue can encourage the nerves to grow and connect to bring back sensation.

In an appointment with me, communication is always open and I follow your lead. You are welcome to tell me all about your birth, you are welcome to tell me if you need to stop or take a break, you are welcome to ask questions as I explain what I am doing and walking you through it. The scar massage portion of your treatment is about 10-15 minutes.

Furthermore, massage isn't the end all, be all. I always, always, always, recommend a postpartum mama go to a pelvic floor physiotherapist. In the same way I assess your muscles, they will assess your pelvic floor muscles and make sure that they are functioning and moving properly. Another option for scar tissue of any kind is Ultrasound therapy for scar tissue breakdown and pain relief. I do not perform either of these modalities so I defer questions about their use to those that do as they will be able to offer more information than I.

As always, check with your care provider before starting these modalities to ensure your incision is completely healed and you get the go ahead for manipulation and massage. More often than not, you can start massage around the 6 week mark.