Postpartum Massage: Recover and Replenish

“Nurture your health, both inside and out.” –Mary Buchan

In general, the first 6-8 weeks are considered the “postpartum” period when the uterus shrinks back to pre-pregnancy size and position. But the recovery process after birth can last for years, especially once the demands of parenting take hold and if there is not a strong support system in place.

Postpartum massage assists mothers in recovery and replenishment after giving birth. Some women are ready for it immediately and others may need several weeks or more. It is important to obtain the go-ahead from your health provider that ypostnatal massage oil candles smallour body is healed enough before receiving massage. It is equally essential to work with a therapist specifically certified in prenatal and postpartum massage.

This form of body work can be a vital part of the healing process as a woman walks through the tremendous transformation that comes with motherhood. It allows for a peaceful time to find balance for the self and meeting the challenges of caring for your little one/s.

The art of postpartum massage can include:

  • reducing pain, soreness, and stiffness
  • stress reduction
  • supporting hormonal balance/regulation
  • reducing swelling
  • assisting the uterus to shrink back to normal size
  • better sleep
  • addressing or prevention of postpartum depression
  • support for resolution of trauma during birth
  • checking for diastasis recti (separation in belly muscles)
  • supportive suggestions for diastasis recti, psoas muscle, and pelvic floor weakness
  • improved breastfeeding as it stimulates release of oxytocin.*

*Oxytocin triggers the milk ejection complex which pushes the milk out of the nipple, making it easier to breastfeed. The more you breastfeed your baby, the more milk you will produce.

C-section scar reduction massage, which includes instruction for self-massage, can help mothers to reconnect with their bellies and their bodies after the impact of surgery. The first 6-14 weeks postpartum is generally considered the ideal time to begin to address the scar tissue, however, only with a doctor or midwife’s approval. But recovery can absolutely still be addressed even years later.

If there was trauma at the birth, it can help soothe the nervous system, support release of painful emotions, and be a powerful therapeutic complement to counseling. We generally cope with trauma by disconnecting from our bodies so massage is a gentle road back to feeling and being present in your body again.

You may have the option to bring your newborn baby to the session. I’ve worked with newborns and mamas on the table together many times. Baby is nestled against mama’s breast in a protective cocoon of propping pillows while we work with the side-lying position. Babies of mothers that received regular pregnancy massage seem to be quite familiar and comfortable back on the massage table. They even seem to recognize and respond positively to my voice!

Therapeutic massage can be a fundamental aspect of the postpartum healing process; it is much more than a pampering luxury. In many traditional cultures, it is an essential aspect of regular care for mothers after childbirth. Healthy, happy mothers mean a healthy, happy society.

Trust Your Gut

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Many ancient cultures, notably in Asia, have called the belly the “second brain” and the “second heart” because it is so sensitive to our thoughts, emotions, and lifestyles. It holds much wisdom and awareness. We have many phrases in our culture that reflect this…

“Butterflies in my stomach”

“I can’t stomach this.”

“My gut is telling me…”

As is often the case, modern science is catching up with this folk knowledge. The new field of neurogastroenterology reflects this shift in that it acknowledges its significance. It and other sciences are recognizing how much the health of our bellies impact our mental states as well as many diseases in our bodies.

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This “second brain”, otherwise known as the enteric nervous system, is made of sheaths of neurons that line our gut from the esophagus to the anus. This second brain contains about 100 neurons. MORE THAN THE SPINAL CORD OR THE PERIPHERAL NERVOUS SYSTEM. The vagus is the major visceral nerve and it primarily carries information from the gut to the brain, not the other way around which means it can work independently of the brain. So our state of being in our belly strongly informs our moods.

Medications that regulate mood such as the anti-depressants, selective serotonin reuptake inhibitors(SSRI’s) often cause GI issues. Our bowels already contain 95% of our body’s natural serotonin so these medications introduce an excessive amount of serotonin. More than 2 million Americans suffer from irritable bowel syndrome (IBS) which is often a side effect. Scientists have suggested that this could be considered a “mental illness” of the second brain.

This is why digestive health, belly breathing to calm and balance the nerves, and belly massage (especially self-massage) to break up emotional and physical blockages and scar tissue are so crucial to both our physical and mental health.

Chi Nei TsangChi Nei Tsang (pronounced “chee-nay-tsahng”) or CNT is an ancient Taoist Chinese form of bodywork and healing art combining abdominal massage with breath and energy work to clear the organs of toxins, toxic emotions, and energy blocks. It can gently work on the surface of the belly as well as working deep into the internal organs all the while promoting deep, centering breathing. Sessions include relaxing instruction on self-care (breath work and self-massage).
One session is beneficial but at least 2-6 sessions are highly recommended.

CNT chart 2

What are the benefits of CNT?

  • excellent for digestive issues
  • breaks down scar tissue from various causes such as surgery (including cesarean section birth) and injuries
  • detoxifies the internal organs
  • clears away emotional trauma and blockage
  • activates lymphatic flow
  • soothes tension in the belly
  • improves mood and mental clarity
  • supports a strong immune system
  • NOT for pregnant or menstruating women

I was introduced to and studied CNT in Tucson, Arizona with Allison Post who (along with Stephen Cavaliere) wrote the book, “Unwinding the Belly: Healing with Gentle Touch”. It is based on the principles of CNT but she created her own style in a very user-friendly interpretation that makes for easy comprehension and application for self-care. I’ve maintained this self-care practice for 20 years.

We can enjoy greater health, peace of mind, and the many gifts that come with self-love when we embrace, value, and care for our bellies. Listen to your gut; it will always have your back.

The Mysterious Psoas

female-hip“It’s in the reach of my arms, the span of my hips, the stride of my step, the curl of my lips. I’m a woman phenomenally. Phenomenal woman, that’s me.”

-Maya Angelou

Most people haven’t heard of the iliopsoas muscle, generally called the psoas (“so’ az”), much less know where it is. The largest and thickest muscle in the body, the psoas connects our trunk to the legs, connecting along the lower back (T12-L5) and involves movement of the back, pelvis, legs, and indirectly, the arms. It is deeply buried under the abdominal muscles and down into the pelvis. Think of the psoas when you enjoy that swing in your hips!

Two Fascinating Facts:
1. It’s the first muscle that forms in the human fetus.
2. When a woman is giving birth the psoas helps to push the baby out.

It’s quite common for postnatal women to report “pain in the buttocks, sacrum and along the crest of the hips in the back”. This is the path of the psoas so it’s often the culpit when it becomes tight and contracted, including the hip flexors.

AREAS WITH SIGNS OF PAIN:
low back, hips, thighs, abdomen during bowel movements, while standing or hanging, even difficulty breathing

CAUSES INCLUDE:

  • “Sucking” in the tummy (yes, allow your belly to breath!)
  • Over training
  • Sitting too long
  • Poor posture
  • Poor muscle alignment
  • Impact of childbirth
  • Scar tissue adhesions after surgery (including c-section birth)

You might call it a “deep feminine” muscle as it can also hold deeply buried emotions and tension, just like the pelvic floor.  Alexander Lowen, MD, creator of BioEnergetic therapy, wrote: ”There is a bottom to our despair. It is the pelvic floor.” Though it’s not technically a pelvic floor muscle, it is a vital part of the same web of connective tissues (known as “fascia”) and also helps create stability in our core and trunk so one invariably affects the other. As children, many of us learn to tighten our pelvic floor as a way of shutting down or repressing fearful emotions and trauma. This is a common response of “flight or fight” by the nervous system as a coping mechanism.

Other spiritual and emotional solutions may be:

  • grounding with the Earth,
  • monitoring stress levels
  • assessing whether you’re feeling supported or not

Connecting with the psoas can open up painful emotions and memories but on the other side is the healing, reclaiming our freedom of movement, vitality, dreams, creativity, and sexuality.

Standard psoas massage tends to be a harsh, painful, and even shocking experience. Therapists may dig down deep into the area without allowing the tissue layers to warm and melt so the body can open up beforehand.

Though not necessarily comfortable, I practice the approach called “Muscle Swimming”, developed by Peggy Lamb, which is a more thorough and gentle method of systematically locating and releasing the psoas, abdominal, and secondary hip flexor muscles which all impact the health and alignment of the psoas itself.

Bellydance movement is also extremely healing for the psoas and pelvis, back, abdominals, and core in general.

It’s important to develop a strong core through proper breath work and exercise but rigorous exercise can be dangerous before the psoas is back in basic alignment. Think SAFE and EFFECTIVE exercise. As with all movement, listen to your body and avoid anything that doesn’t feel right (sharp pain, cramping, etc.) Meet your body where it’s at in the moment.

Here are some basic psoas stretches. Remember to breathe…

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Self-Test: Do you have diastasis recti aka “mommy tummy”?

diastasis recti, a split in the belly muscles, referred to as "mommy tummy" may be disregarded or surgery given as the only option in many cases. But it can be treated through specialized fitness training and massage.

Diastasis recti, a split in the belly muscles, referred to as “mommy tummy” may be disregarded or surgery given as the only option in many cases. But it can be treated through specialized fitness training and massage.

The major reason diastasis occurs is because of a distended belly, almost always due to poor core function. It happens when the abdominal muscle connective tissues stretch and weaken at the midline or linea alba. The left and right sides of the abs look and feel separated.  Poor alignment and doing the wrong abdominal exercises only make it worse. Some hints that you may have a diastasis include low back pain, “mommy tummy” that you can’t seem to heal, and loss of control of your pelvic floor.

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66% of women who have diastasis recti also have problems with their pelvic floor function.

Dysfunctions include at least one of the following:

  • Pelvic floor pain
  • Weak pelvic floor
  • Urinary incontinence
  • Fecal incontinence
  • Pelvic organ prolapse

The gap will become most noticeable when you lie down and relax. The loose skin above or below the bellybutton may seem to sink into the center gap. There may be a jelly like texture to the skin instead of a solid abdominal wall. When you lift your head and shoulders slightly from the floor and engage the abdominal muscles more deeply, you’ll see that the midline or linea alba gap will reveal itself to be deeper and wider.  If your fingers are not pressing into the gap, it may seem to protrude outward, as if the inner contents are pushing out of the midline.

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Checking for Diastasis Recti:

  1. Lie on your back with feet on the floor and knees bent. Arms should be by the sides.
  2. Place your two fingers horizontally into the stomach just above and below the navel.
  3. Inhale.
  4. Then exhale as you raise your head just off the floor.
  5. If there is a gap, the fingers will sink into the abdominal cavity.
  6. One to two fingers’ width soon after the birth is normal and will tighten over time with some modifications to exercise.
  7. Three or more fingers’ width means steps must be taken to close the gap.

Formula for Healing Diastasis Recti (according to The Center for Women’s Fitness)

  1. First Realign
  2. Then Exercise

A pelvic floor assessment with a qualified physical therapist is a very effective starting point. Ask your midwife or OB/GYN, or your doctor if it’s been many years, for a referral. Many of the postnatal health issues in the US can be prevented and treated with this foundational care. It is standard procedure for postnatal mothers in the UK, France, the Netherlands, and Australia. You can find out specifically how to support recovery including whether your pelvic floor is too tense/tight or weak/lacking tone and (whether and which) kegel exercises will help you come back to balance.

Proper breathwork techniques are the first and foundational exercise. They can help to gently rebuild and realign the core and pelvic floor muscles. Breathing should be fluid and not too extreme (neither too expanded during inhales or constricted during exhales).

Some basic breathing exercises:

  • Extended inhales
  • Extended exhales

Avoid exercises that put pressure on your already separated, therefore weakened, abdominal muscles. This includes excessively heavy lifting as well as planks, push-ups, and sit-ups. A postnatal corrective exercise personal trainer is an excellent and effective way to ensure that you will get the customized tools you need to rehabilitate your core and come back stronger and healthier than ever!

Fit for Birth (http://getfitforbirth.com/) is a leading organization in the prenatal/postnatal fitness world and is a great resource for finding a qualified professional in your area. I offer these services in Portland, Maine and Miami, Florida as well as online in live sessions in the US and internationally.

Your body has worked hard to create, nurture, and give birth to your baby. The process of rebuilding the core and healing diastasis recti can be slow, especially if you have had it for many years, so please be patient with yourself.