In my previous blog, I discussed the stigma around labeling childbirth as “natural birth”. More specifically, I examined the introduction of the surgical procedure of caesarean sections in the 19th century and other medical interventions during childbirth. If you haven’t already read the previous blog post, you can here . As a brief summary, caesarean sections account for 18.6% of all deliveries worldwide; in North America the incidence has been as high as 32.3% . Which is to say that 1 in 3 women will deliver via caesarean section.
Increasing rates of caesarean sections worldwide, suggests that more women will endure an invasive surgical procedure, followed by a long recovery period and inevitable scarring will result. Scars, especially a rigid scar, are of top priority to Osteopathic Manual Practitioners. Before we dig into exactly WHY that is, we first have to understand the importance of the fascial system in our body.
What is Fascia?
The fascial system is a large portion of the all-encompassing connective tissue of the body. The fascia lies beneath the skin, beneath the first layer of fat, and surrounds the muscle, bones, nerves, and organs of the body. I like to think of fascia as the ‘cling wrap’ of the body. It intimately wraps around structures to provide reinforcement and compact strength. It is more than just connective tissue that attaches one structure to another. Fascia is pliable and adapts to slow sustained forces by flattening and expanding. It functions very much like muscle tissue or fibers by lengthening and contracting. It is vital that each fascial layer is free to slide, glide and dissociate from one another. A mobile fascial system is what allows for free range of motion in all planes, within the body.
Osteopathic Manual Therapy and Fascia
Osteopathic manual therapist view the body as one integrated system, one which relies on the proper mobility, position and vitality of all structures in the body to function optimally. The inter-webbing of the fascial system is viewed as one cohesive, continuous unit, which serves to protect and support the skeletal framework of the body (Bordoni & Zanier, 2014). The integrity of the fascial system depends on ‘tensegrity’, which means that the fascial strives for balance an equal force distribution across the entire system. Likewise, it means that while some structures are under tension, others structure must be able to compress and accommodate the new forces applies to the fascia. This concept of push and pull is what allows for the equal dissipation of force across the entire body (Stone, 2007). What that means is, that an injury of the fascial system in one part of the body will render that area less adaptive, creating new tension and lead to compensation elsewhere in the body.
Caesarean Section and Fascia
The most common approach for caesarean sections involve a horizontal incision just above the pubic bone of the pelvis. The surgeon will make an incision, in order from outside the body to inside the pelvic cavity, through the skin, subcutaneous tissue, rectus fascia, and the midline linea-alba, the fascial layer where your six-pack muscles meet. The six-pack muscles are separated to gain access to the pelvic cavity. The bladder is often redirected and the uterus is also incised horizontally (Uzoigwe & Jeremiah, 2006). As we heal, these different layers of fascia do not heal individually, layer by layer (that of course would be too easy!). Rather, the fascial layers overlap, interlace and scar tissue forms. Scarring will occur with any type of surgical incision or laceration, it is part of the remarkable restorative nature of the body. Either a caesarean section, perineal tear, or episiotomy, will create a lasting scar. If we recall the physiology of the fascial system and the concept of tensegrity we can see why a scar is problematic in the body. The formation of the scar establishes a new “anchor” or fixation in the body and the fascial layers are no longer able to glide or dissociate freely. Scar adhesions disturb the fascial continuity and generate congestion between the different layers of fascia.
So, what can you do about these sticky fascial layers?
Treatment of Scars
Please note that all of these techniques should NOT be performed until your incision has completely healed. This means, you have seen your doctor for a follow-up post-surgery, you have no signs of infection, your stitches are out or dissolved and you have no more open lacerations or scabs in the area. These techniques can be applied to any abdominal scars, like laparoscopic scars, appendectomy scars etc.
Self-Massage
Self-massage is a great place to start for new mothers who have had a caesarean! After you are beyond your critical six-week post-op recovery time and your stitches have disolved, you can start to mobilize the scar on your own. I recommend after a warm shower, applying some organic oil on your fingertips, coconut, almond or castor oil will do! Lie on your back, knees bent so that your belly is in a relaxed state, take a little bit of oil onto your fingertips and begin by just going side to side over the skin above your scar and below your scar. This may feel weird at first, take your time and be gentle! Try to stick with it for 5-10 minutes a day.
Castor Oil Hot Packs
After you have become accustomed to the self-massage techniques try this!
Castor oil PLUS heat will increase circulation to the area you are trying to target. The castor oil hot pack will draw more blood to the area and encourage the breakdown of old scar tissue, improve the mobility and the appearance of the scar. Body Co., carries OJA organic castor oil and flannel packs to help you get started!
See a Manual Therapist!
Out of the subjects recruited for my recent research, “The Effects of Global Osteopathic Treatment on Diastasis-Rectus Abdominus in Postnatal Women”, 30% delivered via caesarean. Mobilization of the C-section scar was always how I began to treat osteopathically. In the literature, scar adhesions disturb the fascial continuity of the core canister and have been recognized as one of the greatest aggravators of diastasis-recti abdominus. If you feel uncomfortable doing any self-massage, seeking an Osteopath for scar treatment is a great alternative. They will assure that all the different layers of fascia are mobile, all the way down to the deepest layer of your scar formed on the uterus!
Should you feel you would benefit from scar treatment and would like to learn more about Osteopathic manual therapy for scars, it is best to make an appointment at the clinic!
Florence Bowen
Florence was first introduced to alternative therapeutic modalities in her teens, as a dancer and competitive athlete. After high school, Florence furthered her dance training and obtained her Honors Bachelor of Science in Kinesiology from McMaster University. Teaming up with the artistic director of the McMaster University contemporary dance company, she developed introductory dance classes for children and teens across Hamilton. Inspired to further her teaching skill-set, she obtained her yoga teacher certification in Hatha yoga. Florence teaches across the city and combines her knowledge of human kinetics, dance, strength and conditioning, and yoga. Teaching movement to pre and postnatal women, and coaching as a birth doula, she gained a unique perspective into the supportive systems available to new and expecting mothers. Florence has an affinity for the holistic approach to women’s care. She is passionate about the assimilation of progressive knowledge to educate and empower women at any stage of life including: pre-conception, pregnancy and recovery after birth. Most recently, Florence completed her five years of study at the Canadian College of Osteopathy in Toronto. As a manual therapist, she believes in having her patients actively participate in their healing. She currently is working to complete her thesis which will examine how osteopathic treatment effects diastasis-recti abdominus in postnatal women.
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