Have you had a cesarean deliver? Are you hoping to get pregnant again?
In this post, we discuss why it is imperative to do extensive post-surgical scar care and massage after a cesarean (or any abdominal surgery, for that matter) before trying to conceive again.
Congratulations! You had a beautiful birth with a beautiful child to show for it! You’ve been working hard as a parent, establishing a bond with your baby, while managing life’s other obligations, and- you’ve healed your body. The stitches are gone, the swelling is down, you’re starting to fire those abs again. You’re healed! Or are you?
Cesarean births, though commonplace nowadays, are major abdominal surgeries. There are some variations in the approach that the surgeons take, but most likely you can see your scar running horizontally on your low belly, between the hip bones. This is the visible scar- the scar that most people talk about, worry about healing, and try to prevent from becoming keloid. This is the first incision the surgeons make. Below the skin layers, they have to cut through many other layers of tissue including fat, abdominal muscle, highly complex networks of connective fascia, and finally, the muscle of the uterus. Typically, some of those deeper incisions are done vertically, so below your horizontal scar, there is deeper scar tissue that runs up and down in your low pelvis. Take a look at this instagram post visualizing the incisions through the various layers of abdomen. THIS is the scar tissue that causes problems. Problems with digestion, problems with low back pain, and problems with fertility.
Most likely, you’ve gone to your doctor for a 6-week post-op/post-birth checkup, at which you’ll be ‘cleared’ for regular exercise, sex, etc… giving you the impression that you should be healed up and ready to go run a marathon, have more babies, and be on the move. But for the vast majority of women, this is not the case. We need more time, more rest for our bodies, and a much stronger focus on healing the scar.
Scar tissue is the body’s rapid, intelligent response to trauma. It is fibrotic connective tissue that is laid down rapidly to mend a wound. In this fast patch job, the fibers of the scar tissue lay down in a chaotic manner, rather than an orderly manner that respects and abides by the preexisting boundaries and relationships between body structures. Your body is doing damage control, and it’s not too worried about precision. Therefore, the scar tissue can become rigid, it can lack blood flow, and it can bind up adjacent tissues. It can ‘spread’ almost like a web to its neighbors, whether they are injured or not. Scarring can inhibit full movement of the tissues, thereby preventing proper functioning of those tissues.
What you see on the surface is just the tip of the proverbial iceberg of the scar.
Depending on the surgeon, the extent of the incision, and depending on how your body lays down the scar tissue, your body can have extensive scar tissue that affects the small intestine, the bowel, the ovaries, the uterine (fallopian) tubes, and of course, the uterus that suffered the most direct impact.
This deep pelvic scarring impacts future fertility.
For example, scarring on the ovaries can impact robust hormonal responses and ovulation, scarring on the tubes can impact the ability of a fertilized egg to travel to the uterus, and scarring on the uterus can impact healthy implantation, and the ability of the uterus to expand and shift with a pregnancy. Even if there isn’t a cesarean-related isthmocele (niche or pouch in the uterine muscle), the immovable, fibrotic nature of the scar impacts the blood flow to the cells of the uterus, and the organ’s mobility. These are some of the reasons why many people experience infertility after a c-section.
Hands-on bodywork and scar mobilization is simple, effective, and nourishing to the whole body.
Deep, intentional massage and mobilization of the scar tissue, both the surface-level horizontal and the deeper vertical scar can make an enormous difference in postpartum healing and in preparation for conceiving a subsequent pregnancy. Therapies like Mercier Therapy, when done consistently along with self-care, can restore movement and vitality to the scars. There is nothing that can fully take away or heal scar tissues, but scars can be shifted and improved over time to be less intrusive, and less consequential. Bringing mobility and vitality back to the scar can help us conceive subsequent pregnancies, improve sluggish digestion, and restore movement and flexibility to our whole bodies. Check out this video of UFC fighter Julianna Pena explaining how Mercier Therapy helped her recover from her cesarean birth surgery.
Scar tissue remediation is a long (even lifelong) process, but an initial treatment like Mercier Therapy can help kick off the healing process, and is able to address the deep levels of scarring more effectively than self care massage alone. Scar tissue work can be initiated 6-8 weeks after birth, and the earlier you start, the faster the scar response will be. That said, any time is a good time to work on your cesarean or any other scar. This work can be profound, even if the scar is 3, 5, 20 years old. Its better to address your scar tissue late than never.
If you’ve had a c-section, and are planning another pregnancy, do not ignore your scar. Seek help and work on the scar yourself. At a bare minimum, start a regular practice of castor oil packs and abdominal self massage. If you can, find a practitioner in your area who offers Mercier Therapy or scar tissue remediation. Your whole body will thank you, and your conception journey will be easier.
Have questions, comments, thoughts? Get in touch!