So you gave birth via C-section, now what?
Pregnancy can be a super exciting time but with that excitement often comes the weight of expectations. While each pregnancy has some predictable factors, there are always a few remaining variables including how baby will enter the world. C-sections can be necessary for a variety of reasons and account for ~32% of all births in the US and a bit less internationally. It is important that moms are aware of healing strategies after this major surgical procedure.
A C-section requires the incision of ~7 layers of tissue to include skin, connective tissue, fascia, fat, abdominal muscle and organ (uterus).
As a result of this incision, wound adhesions often occur between these layers. Adhesions can create a variety of symptoms such as pain, tension/pulling, muscle inhibition (inactivation), core dysfunction, weakness, referred pain in low back/hips, painful sex, and pelvic floor dysfunction. The incision itself can also result in numbness on and around the incision. One major way to combat adhesions and abnormal sensation is through scar mobilization.
Scar mobilization is the intentional use of hands or tools to move tissue on, around and below the scar to restore function and mobility. This can be performed on oneself with a variety of manual (hands on) techniques, with the use of tools such as partially deflated Pilates ball, or by a physical therapist. It may be appropriate to begin mobilizing as early as 3 weeks post operatively, but mobilization techniques can be effective at making tissue changes indefinitely.
So, it’s never too late to make changes and oftentimes, women are experiencing symptoms without realizing they are related to scar tissue adhesions.
Another important aspect of scar tissue management is restoring sensation.
Many moms report numbness, tingling, or a generally abnormal feeling in the skin on and around the incision. They may also report emotional overwhelm or fear at the thought of touching or moving the incision, as well as emotion related to the circumstances surrounding the cesarean birth.
This abnormal sensation combined with fear/emotions may prevent moms from beginning a mobilization program. Ironically, touching the scar is the key to de-sensitization both physically and emotionally. Such techniques are widely used in rehabilitation of persons with amputations and can help the brain adapt its perception of the healing tissue.
In current practice, instruction in scar tissue mobilization is rarely a standard of care for the postpartum well check. Because of this, many moms are led to believe that because the “skin” wound has healed, no further intervention is necessary. This simply does not align with how other surgical wounds are addressed. Scar tissue mobilization is a well established practice in orthopedic surgical rehab for procedures such as ACL reconstruction, total hip/knee replacement, or shoulder decompression. The same techniques are incredibly effective and necessary post C-section.
C-section or “belly” births can carry a myriad of emotions (not unlike vaginal births), and can leave moms feeling relieved, disappointed, confused, afraid, grateful, sad, elated, left out, joyful, less than, & uncertain. Scar mobilization can help normalize sensation, improve tissue mobility, ground & release emotional tension, and improve functional mobility.
Motherhood requires strength, endurance, and mobility in highly unpredictable patterns (cue wild toddler risk taking). It is so important that moms are connected with holistic healing interventions to help them feel and move their best.
I’d love to connect with you in our upcoming C-section Scar Mobilization webinar and discuss the specific techniques/parameters for mobilization as well as the signs that a scar may have adhesions. It is never too late to mobilize scar tissue and any amount of mobilization can create improvement.
As a C-section mama x 2 and physical therapist, I am passionate about sharing these resources with any moms in need!