Postpartum Bodywork:
Advice for the Postpartum Massage Therapist
By Chula Gemignani
Instructor of Massage, Author, Bodyworker and Developer of
Dynamic Fascial Response™

In terms of bodywork and massage, what happens after the baby is born?

Every birth is so different but generally what I’ve experienced is that after birth there’s a time that my client will be retreating, adapting to their new life and bonding with their baby. If I wasn’t present at the birth then I make no assumption about what’s taken place. Rather than sending congratulations, I’ll send a message expressing curiosity in how my client is doing. This avoids any assumption that everything is well when there’s a possibility that there may have been complications. This way I’m sure to stay in rapport. I’ll let them know that I’m here for them when they need me for postpartum bodywork or a relaxing massage.

Once your client is ready to receive a massage they’ll invite you to a house call or will come into the office. If you don’t hear from them regarding postpartum massage, an email to them that educates on the benefits of postpartum massage with a coupon attached may be just what they need to ignite their attention towards self care once again.

How soon can I massage my client after birth?

As soon as your client is comfortable to receive it and there are no known complications.

Post Cesarean: Any abdominal massage or any core recruitment requires a wait until about 6-8 weeks when scar is healed and scar tissue is formed.

Why is postpartum bodywork necessary?

I can’t stress enough the importance of postpartum bodywork. Blending postural opening and balancing with relaxation massage is the key. The emotional load of new parenting, the lack of sleep, and the physical recovery as the body’s displaced muscles, organs and bones find their way back into place all will benefit from the integrating postpartum session.

How can I help my client’s improve their posture?

Anterior Unwinding of Repetitive Holding Patterns

The positions and activities of early parenting can be compromising to the body most of the day, every day creating repetitive holding patterns in the anterior (front) fascia. Looking down is one of the many gestures responsible for this. Forward head posture (FHP) is what causes neck and shoulder tension in new parents. Imagine the number of diaper changes, the amount of nursing hours, not to mention the hours gazing down in awe at this beautiful new arrival. And then there’s the weight of the breasts pulling the thoracic spine forward. The tension in the back of the neck and shoulders usually is coming from the constricted fascia in the front. According to Kapandji (Physiology of the Joints, Volume III), for every inch the head moves forwards, it gains 10 pounds in PSI weight. A normal 12 pound head can turn into a 32 pound head respectively. This gets translated to the muscles in the upper back and neck and they have to work much harder to keep the head (chin) from dropping onto the chest. FHP also forces the suboccipital muscles (they raise the chin) to remain in constant contraction, putting pressure on the 3 Suboccipital nerves.

This is why ventral and abdominal anterior unwinding is needed in massage for any new parent to help support good posture and to release neck and shoulder tension.

What should I expect during a postpartum session?
The client finally gets to lie on their belly and back or any position during their postpartum session. Their breasts may be sore and full of milk. A memory foam topper is helpful.

What do I do if my client leaks? MER Milk Ejection Reflex / Letdown (“Leaking”)
Breasts may leak breast milk during the session so provide a towel for your client to place under or over breasts whether lying prone or supine. The hormone oxytocin causes the milk ejection reflex (MER) or letdown.

If my client’s baby wants to nurse during the session, how do I accommodate a nursing baby? I always let them know that their baby is welcome to the session. Your client will appreciate this gesture of support. Ask them to bring someone to care for the baby if possible and inform them that if baby needs to nurse during the session it wont pose a problem because you can always switch to side-lying and still get a lot of bodywork done while their baby is nursing. Knowing this, you may want to save low back and hips for the last part of the massage just in case you find yourself working on a side-lying, nursing client. There is also the possibility that your client may not be ready to be separated from their baby at all and so you may have a fun and adventurous massage with a baby present. Think about adding a memory foam topper to your massage table for your clients comfort in side -lying positioning.

What positions are OK for postpartum massage? All positions are safe unless compromised circulation is present in which case you would use left side-lying.

Side-lying if breasts are sore (usually first few weeks) or if client needs to breast feed while in session.

Are there postpartum massage contraindications?
There are many warnings and contraindications and it’s important that you are certified in pregnancy massage or have learned those before proceeding with massage.

What if my client had a C-section? The importance of gentle and soft abdominal massage is crucial after a C section to help break up scar tissue. The surgeon’s cut may have been precise but scar tissue forms differently for everyone, sometimes irregularly and may even form adhesion over internal organs. Gentle massage will help break up those scar patterns so the client does not have unwanted back or pelvic pain. Adhesion can also prevent further pregnancies which is another reason to be sure to offer abdominal massage. There are time guidelines and contraindications for post C section massage that a massage therapist would learn in a certification course.

Is it OK to let my client talk during a session?

Emotional unwinding Your client has just gone through one of the biggest passages of their lives and will probably want to share with you their birth experience as you work. Allow for this unwinding with a listening ear. Eventually she will drop in to receiving and telling her story will help the process of letting go into the present moment. The more present they can be with themselves, the more present they can be for their baby.

What mechanical advice can I give my client?

Watch your posture, try not give yourself away.

When picking up child try not to bend over.  Instead, squat to pick up child, try a kegel and push feet into the floor to stand while engaging glutes.

Counter stretch whenever possible especially after long held positions like nursing.

Try not to favor one side.

Try slightly tucking chin to help improve suboccipital tension.

Take walks

Alternate sides when holding child.

Stay hydrated, set a timer on phone for water intake.

Sleep when baby sleeps.

Yoga, pilates, or joining a postpartum exercise class can help recruit the core when the client ready for that.
It’s good to encourage them but your client may not be ready, so be sensitive to their process and stay in rapport.

The next 5 Day Pregnancy Massage Certification in DFR Bodywork is
Feb. 15, 16, 17, 23, 24. Pre-registration discounts will expire after Jan 1, 2019. Class is limited in size and registration closes after 12 students are enrolled.
Visit DynamicFascialResponse.com to register
Email inquiries to: info@DynamicFascialResponse.com
Include Subject Header: “Winter Pregnancy Massage Certification ”

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