Issue link: https://www.massageandbodyworkdigital.com/i/68185
MASSAGE FOR CESAREAN SECTION CLIENTS C-section Massage Protocols While clearly not a comprehensive list of protocols for working with the postoperative C-section client, consider these caveats: • DO NOT attempt any work on her abdomen, especially over or around her incision, without written permission from her doctor. • DO NOT massage directly over varicose veins. • DO NOT massage the inner thighs or the popliteal areas to avoid dislodging thrombi (causing emboli), or causing trauma to veins (phlebitis). Pregnant and postpartum women are at increased risk for developing deep vein thrombosis (DVT), which can have life-threatening consequences. • DO NOT perform deep work on the calves. Refer the client to her physician if you notice heat, swelling, or redness of her calves, or if she has increased calf or popliteal pain with foot dorsifl exion when her knee is fl exed at a 90-degree angle (Homan's sign). Avoid all leg massage, including Swedish massage strokes, if she has been on extended bed rest. • DO encourage her to breathe deeply to expand her lungs. Teach her to "splint" her incision by holding a pillow to her abdomen to reduce pain when breathing and coughing, as necessary. • DO provide extra pillows to support her lactating, tender breasts, and realize she may be more comfortable wearing her bra during the session. Provide extra towels on the table, both to protect the surface and to reduce any embarrassment about leaking milk. • DO realize that lochia (vaginal discharge) may continue for up to six weeks after birth. Provide adequate draping for modesty and to accommodate underwear and sanitary napkins. • DO realize that you may need to interrupt the session several times for her to empty her bladder, as water retained during pregnancy is eliminated early in the postpartum period. • DO reassure her that excessive perspiration during this time can also be a normal method of eliminating retained fl uid. • DO remember that an epidural site on her back may be tender. • DO remember that a post-Cesarean client is also recovering from major surgery. All precautions for working with post-surgical patients apply. connect with your colleagues on massageprofessionals.com 69 I will work with a woman as soon as 24 hours after delivery, if she had a vaginal birth with no complications. If there were any complications, or if the birth was by Cesarean, I will work with her only if she brings a release from her OB-GYN authorizing massage therapy, or after she has been released from the surgeon's care after her six-week postpartum visit. I have a standardized release form that I send to her doctor, advising him or her of the work that I plan to do and asking for a list of any limitations or precautions they want me to follow. What if you walk into the room to begin a massage session with a client, and you fi nd out that she is not only postpartum, but also less than six weeks post-Cesarean? Consider carefully whether or not to continue the session. If you decide, for whatever reason, to work with her, be as safe as possible. Many of the concerns and precautions applicable to pregnancy massage will still apply for up to 8–12 weeks into the postpartum period. THE EMOTIONAL SCARS During and after the surgery, physical damage reports fl ood the nervous system. As a surgical nurse, I've noticed that even while totally anesthetized, a patient's heart rate and/or blood pressure can go up in response to certain aspects of the surgery. Unconscious psychological controls can be activated, potentially producing anxiety, jumpiness, a lowered pain threshold, even a subconscious feeling of betrayal and anger at the person(s) who caused the experience. Emotions may not be rational, but are valid. They can't be explained or justifi ed; they just are. As a massage therapist, I've noticed that a medically necessary, planned C-section which resulted in a beautiful, healthy child, may still bring about emotional