Why waiting 6 weeks after birth to have a massage makes no sense

There is a belief in our culture that a new mother needs to wait until 6 weeks post birth before she has a massage.

Since I became immersed in the postpartum and since I learnt to massage new mothers, and since I did the research for my book, Why postnatal recovery matters, it has become clear to me that not only does this makes no sense, but it is potentially harmful, because it means that new mothers miss out on much needed nurturing and healing when they need it the most.

We seem to believe that we have to wait until we’ve had our 6 weeks check before we receive any treatment, but the 6 weeks check with the GP does not include any whole body physical examination, it’s just a 10 min discussion appointment. Therefore it makes no sense to wait.

I wanted to know where the idea came from, so I asked massage therapists on social media. It seems from discussions that this is just a belief, rather than evidence based, and that the restrictions may have come from some insurance companies, rather than from any medical evidence.

It’s old and outdated advice although I do think it’s helpful for therapists to have knowledge of how to work postnatally if they are going to work soon after birthing. For example, a level new three therapist with no previous experience would likely feel quite out of their depth. Training schools used to teach (and some probably still do) that the first six weeks were contraindicated and we were to wait for the g.p check before going ahead. It’s due to the ‘complimentary’ nature of the service as opposed to being an ‘alternative’ from allopathic medicine. Emma Kenny, massage therapist

It is actually really helpful to massage in the first 6 weeks postnatally as long as you know what you are doing. There are many modifications and it is a potentially dangerous time so you need to know the contraindications too. It is also partly because the mum is still under medical care. Main issues are high risk of infection and of course knowing how to modify after different kinds of birth.  Suzanne Yates

“The Royal Free London used to offer seated massage within hours of giving birth, in your postnatal ward bay. It was an amazing service and one that I took full advantage of after the birth of son (5yo). Sadly I think this is no longer offered.” Anna

Why bodywork is important for new mothers

Given the tremendous changes a mother’s body goes through, it is perhaps not surprising that cultures the world around have in common some kind of bodywork to rebalance and restore the new mother. I’m not talking about just any random massage, but a specific kind of bodywork designed to help speed up the healing process and changes that the new mother’s body undergoes after her baby has been born.

When a woman grows and births a baby, her whole body undergoes remarkable transformations. Her uterus grows from the size of a pear to that of a watermelon. Her pelvis tilts forwards, the curves of her spine increase, the muscles and ligaments around her belly stretch and grow. The organs inside her abdominal cavity get pushed up to accommodate her growing baby. During the birth, her uterus, pelvis, pelvic floor and vagina open and stretch to let the baby out. Then, after the baby is born, her body has to undergo all those changes in reverse. These changes also include tremendous hormonal changes, and the beginning of lactation.

With this in mind, it feels extremely illogical to me that we no longer have any process in place to ensure that all the bones, soft tissues and organs have gone back in an optimal position. All new mothers would benefit from some kind of “MOT” post birth from a postpartum manual therapist, because it is easier to prevent, or treat problems as they arise, rather than letting them set into a pattern that becomes a lot more difficult to resolve. Traditional postpartum wisdom across the world includes massage, binding and manipulations designed to help speed up this healing process and avoid future problems. Besides the therapeutic effect of specific bodywork, any type of massage is good because loving touch raises feel good hormones like oxytocin.

The lack of bodywork support and the view of the postpartum body in the West.

There is a lack of postpartum bodywork support, and a lack of understanding of what is normal post birth, and of what constitutes acceptable postpartum ailments. Issues like stress incontinence, diastasis recti, or uterine or bladder prolapse, receive very little skilled support, are often seen as part and parcel of motherhood and contribute to the lack of support for new mothers. In the UK, new mothers are generally given a leaflet about pelvic floor exercises, which can help some women, however, without knowing if you are doing it right, and connecting it with the breath and the rest of the core abdominal muscles, it doesn’t make much of a difference for many women. Without support in place, it can also be difficult for new mothers to find the time do to these exercises. The check-up that women undergo with their GP at 6 weeks post birth is a standard, 10 min appointment that includes questions but no whole body checkup examination.

When to have postpartum bodywork?

French medical doctor and yoga teacher Dr Bernadette de Gasquet, who specialises in birth preparation and postnatal rehabilitation, explains in her book Mon corps après bébé that the first 6 weeks after birth is a transitional period, when everything is soft and pliable, and that there is the most opportunity to heal from the birth. She recommends a programme of simple exercises to help make use of this unique time. In another book called Le mois d’or she also explains the importance of closing the pelvis, and quotes the dissertation of a French midwife who chose to study the subject. I read the dissertation in question, which is, as far as I’m aware, the only scientific study of postpartum binding that exists. The author, Juliette Danis, used a simple binding around the pelvis, applied the day after the birth (in hospital) for an hour. In a group of 160 women, 64% of women described an improvement in their pelvic and perineal pain, and 79 out of 80 of the women who received the binding said they would recommend it. Danis concludes that the care given to the women after the birth using massages or wrapping has a positive effect both physically and psychically, and that it symbolically helps to redraw the contours of the body.

In every continent, postpartum specific bodywork is (or was) part of the normal care for the new mother. This kind of bodywork often includes massage and binding with a cloth. Each culture has a slightly different approach, but the goal is to restore and “close” the mother after the birth, and help speed up the natural healing process. These massages usually encompass the understanding that there is a physical process that needs to be completed (helping return the body to its non-pregnant state), and an emotional/spiritual aspect too (honouring the birth process and the emotions associated with it, as well as the tremendous changes of identity that the new mother undergoes).

Nearly ten years ago, I learnt a postnatal massage from South America called Closing the bones. The massage includes rocking the pelvis with a rebozo (a traditional Mexican shawl), a series of massage of the abdomen, hips and chest/arms, and finally using the rebozo again to wrap the pelvis, and the rest of the body, tightly. I have been giving this postnatal ritual to hundreds of women, as well as training many people in offering it. More than a massage it is also a ritual that celebrates and honours the new mother, and can be very healing both physically and emotionally (regardless of whether the birth was a positive experience or not).

Having massaged many new mothers, some as soon as 24h after the birth, I can personally attest that it makes complete sense not to wait to provide some bodywork. Treating the widened pelvis, the flared ribs, the shrinking uterus, the bowels moving back into their original place, the changes in the breasts as the milk comes in, all the amazing transformative processes that the new mother undergoes within the days and weeks after the birth, as they actually occur, facilitates and speed up  healing and recovery.

Obviously, this needs to be adapted depending on the birth (vaginal or cesarean in particular), and the physical condition of the mother. However, it is also a myth that nothing can be done post caesarean, because binding has been shown to have advantages post abdominal surgery. Cambridge osteopath Teddy Brookes, with whom I developed and teach a massage called the postnatal recovery massage , told me how he massage a new mother 2 weeks post caesarean to help the passing of retained placenta and membranes. This was for someone who had been told she needed surgery. She passed the membranes the next day, therefore avoiding surgery. I had myself had similar experiences.

I believe that a blanket time ban doesn’t serve new mothers and that each individual case needs to be looked at on a case to case basis, assessing the level of risks and benefits of treatment to each individual mothers, and adapting the treatment as required.

 

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