October 16, 2011

Postpartum Massage

Pregnancy massage gets talked up a lot. I talk it up myself: it's great stuff, and it's fun to work with pregnant bodies. Pregnant bodies are stoked, hormonally: you can practically feel them growing under your fingers. They're vibrant and responsive. They feel extraordinarily alive.

Lots of people give gift certificates for massage to pregnant women. My impression from surfing the web a bit is that pregnancy massage is a booming business. And that's grand: but I tell you, if my budget allowed for only a few massages, I'd save them up for the postpartum year. That's when women need it most, and when they get it least.

Pregnancy stresses the body, but it does it relatively gradually, and the hormones surging around, while they are not always easy to deal with, at least always remind you that you're doing something out of the ordinary. During pregnancy, and especially during a first pregnancy, things feel rather epic. Your body changes drastically, and everybody's into it, often annoyingly: strangers, without permission, will be placing their hands on your belly and exclaiming. Interest in the last couple months is intense. Everybody wants to know: when are you due?

Then, bang, the birth. Huge to-do. Lots of excitement. People cooing over the baby, pictures flying around the web.

And then two weeks later – it's all done. Nobody's interested any more. The party's over. Just when you really need the support, when the new life is really starting, you're on your own. People may still be interested in the baby, but they're no longer interested in you. Your body, which was the center of the world and a matter of absorbing interest, the temple of new life, is now a seedy all-night snack bar. It has, in the space of a few days, gone through huge changes, and it has challenges every bit as big as the challenges of pregnancy to deal with. If you've had a C-section, you've got major surgery to recover from. If you had a hard labor, you have exertions and injuries to deal with that make running a marathon look paltry. In either case, especially if you've been primed by overly chirpy birth-preparation books, you're liable to feel that you somehow failed by not have an easy, radiant birth.

Even if you had an easy, radiant birth – some people do – what your body now has to accomplish is extraordinary. The uterus has to return to its former shape. All your displaced abdominal organs have to find their way back home and re-seat themselves. Your abdominal muscles have to shrink to a third of their high-tide size and recover their tone. All the ligaments and connective tissue has to tighten back up. Your nervous system has to rewire its sense of where your body is in space. And this while, in all likelihood, you're working harder, and sleeping less, than you ever have in your life. But now – at least by comparison to the glories of pregnancy and birth – nobody really gives a damn. No strangers are rushing up to coo over your shriveling stomach; nobody wants to congratulate you on the fact that in some lights your stretch marks will hardly show at all.

What surprises me, really, is that anyone doesn't suffer from postpartum depression.

This is when you need massage. When you need someone focused on helping your body, which is working harder and changing more rapidly than ever. When you need the soothing and the comfort and the being-made-much-of. This is the time when you're most in danger of losing touch with your physical self, when you're ignoring warning twinges and discomforts and spasms because you're too damn tired and there's no time to do address them: when you're tempted to stop caring for your body because nobody is interested in it anyway. This is when you realize that your body is going to be different now forever (it is) and that it's lost all its resilience (it hasn't: it's just that the big hormone party is over.)

Why don't more women get massage postpartum? Lots of reasons. Here are some bad ones:

Sometimes bowel or bladder are untrustworthy for a couple weeks postpartum. Any experienced massage therapist should be prepared to deal with that. Bodies leak: so what? You clean up and go on. No problem.

You can't get childcare. You still have options. There are places, in large cities anyway, that offer childcare as part of the package. There are a number of massage therapists who, like me, offer in-home massage and are not fussed by having an infant on the table with Mom, nor by wide-eyed older siblings wandering into the room from time to time to ask for things. I have clients who get their massage sidelying, with the baby snuggled in and nursing from time to time.

You're too tender to get massage. You do need someone who understands what the body goes through, in childbirth and after. Do find someone who thinks that massage should not, ordinarily, hurt. There are times when trigger point or deep tissue “hurts good,” but that's a special case, and the therapist should know exactly what they're doing. You neither need nor want to be manhandled, postpartum.

Your belly is still too big, or your breasts too sore, for lying face-down to be comfortable. But there's never any need to be face down, any more than there is during pregnancy. Your therapist can arrange you on your side perfectly comfortably. It's a little mysterious to me how little massage is done sidelying. In many ways it's much better position than face down: I can move the top shoulder freely, any way I want, and the hip rotators are much easier to get at. I can't get as much leverage on the thick lumbar paraspinals, but on the other hand, the pressure I do use isn't bearing down on the still-tender abdomen. I have longtime clients who took to sidelying while pregnant, loved it, and now, years later, have no intention of ever getting back on their face.

You're too ugly. This is a surprisingly common reason. I guess it comes of all those spa ads with gorgeous perfect women luxuriating in a massage: you feel you don't look the part, so you'd better wait till you do. But this is exactly backwards. The problem is not that you're ugly: the problem is that you feel ugly. And nothing dispels the delusion of ugliness like a good massage. You always deserve a massage. You don't earn the right to it by being lovely. You earn the right to it by being a human being.

Those are some bad reasons for not getting massage. There is often, unfortunately, one good reason: it's too damn expensive. So plan ahead. Make clear that one of the baby shower gifts you'd love to receive, in lieue of yet another darling onesie that will be too small in five weeks, is a certificate for an in-home massage. Or for a package of in-home massages: the perfect thing to hit up a rich aunt and uncle for. And remind your friends who were so free with offers of babysitting before the baby's arrival, but have since become too terribly busy, that a massage certificate is an acceptable substitute.


  1. Awesome post, Dale! A wonderful blend of physiological facts and your empathy for what the pregnant and post-partum women are experiencing.

  2. Absolutely. Postpartum women are my favorite clients, personally. The body has been through (and continues to go through) a tremendous amount of physical and psychological stress. My own neck is still recovering from 2 years of near permanent flexion and rotation from breastfeeding and looking down at my little radiant being of sweetness and light. There is a huge need for quality postpartum physical care. Thanks for addressing this!

  3. Thanks, Lisa! Yes, I feel it's some of the most obviously useful work I do.

  4. Seedy all-night snackbar! Oh, that made me laugh in rueful memory.

    This is a wonderful post.

    1. I cackled at that one. SO true.

  5. Beautiful post, Dale.

    I love reading your writing about your work, and so wish we didn't live so far apart - I'd be referring to you constantly (and coming myself, when I could!).

  6. Thanks so much, Jessamyn! I wish you were here!

  7. "You always deserve a massage. You don't earn the right to it by being lovely." That may be one of the loveliest things I've ever heard . . .

    1. Thank you! I wish more people really got that.

  8. You know, two of the things that made me *almost* not get massage after having baby#1 were
    1: the fact that my breasts were leaking and that I might need to pump to get some relief (since I had just gotten out of work -- having gone back to work at 2 weeks)
    2: I was still having post-birth yuck coming out of the nether regions. I felt SO self conscious because I chose to wear underpants. I had NO idea that wearing undies might be acceptable at all.
    By baby#2, I no longer cared, and got massage gratefully, but for the first, yeesh. SO much misplaced concern and modesty.