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Hail Caesar (ean)!

Apologies for the terrible title. But how do you blog to appreciate the caesarean while also allows for the damage it does to you? In structural terms, it cuts right across a very important part of the way we hold ourselves upright and can lead to some long term issues if we don't ever come to re-integrate this tissue back into our movement pattern. But on the other hand, it will hopefully have given us a healthy baby, avoided possible damage to the pelvic floor and avoided the type of intervention which would otherwise have had to happen (high forceps anyone?) to save lives. So yes, I am a huge fan of the Caesarean given the immediate problem that has to be solved. I am hugely thankful for the medical world for developing and carrying out this surgery. No ambiguity on that for me.

But what about the longer term effects? The scar can be small, brilliantly camouflaged under the knicker line on the surface and you just get up and get on with the job of carrying around a small but surprisingly heavy baby. But what has happened and what have you done to not strain the area while is heals? How has that impacted your ability to use all your body? And what about the pulls and discomfort that some women have? And what about the emotional tension in that area because you don't feel it is safe, or acceptable, or beautiful? In the UK we don't have any regular habit of physio or rehab after caesareans, and this is a major missed opportunity.

The abdomen is multi layered - there are tissues running in many different directions and at different depths. They should all be able to move differentially, like a number of sheets of fabric all laying across each other at different angles. And they should be able to rotate and move somewhat independently of each other, with a central rotating point around the navel/belly button. But then a caesarean makes another pretty fixed point as the fabric in the lower abdomen is cut and then essentially sewn together to make a sort of multi-layered darn in what used to be a continuous, smooth set of fabrics. Some surgeons make a point of trying to sew up the layers as independently as possible - good seamstresses. Others are less skilful, or under too much time pressure in a busy hospital. Often the sewing up is left to less experienced surgeons. So not everyone has a similar experience, each operation is unique.

The horizontal cut we see on the surface is not even the full picture. It is made this way partly for presentational reasons - 'old style' caesareans were often vertical on the surface. 'Modern' ones may be horizontal at the knicker line, but are vertical in the layers below, and the incision is then held open with surgical equipment which holds the space open while the surgeons work and the uterus and baby are reached. So there are different directions of strain, space and sewing to envisage. Not quite the simple 'too posh to push' picture that some may have in mind.

Some women notice the effects and compromises that a caesarean causes in their body. Some women don't. But both suffer some changes and alterations which can cause rapid or delayed difficulties with their back or hips, or neck, or knees. Who knows where you will have to pay the bill for that disturbance in your overall supportive structure. But I suspect that there will for everyone be something to pay.

My interpretation of working with caesareans is NOT strength. In fact it is re-layering, letting go, finding length again. Recovering the potential to rotate, to allow movement through this tissue, and to trust the lower abdomen again. To allow it to let go and get involved. To trust it again. To let any trauma dissipate. And to do that we need to work gently but clearly.

I work on the line across the body - the hoop/ring structure of the mid-pelvis which covers in particular the pubic bone, pubic ramus and their relationships with the greater trochanters of the hips. And I work on the longer diagonals - connecting the ribs to the pelvis across the internal and external obliques. And I work on the verticals - long the rectus abdominis. And I work on how this all affects the pelvic floor - one long line from/to the back of the body to/from the front. All of which are mainstream Rolfing territory, but with a personal and deep understanding of what it is like to have this challenge. I did my Scar Work course because of my own experience of having these scars, and found a really rich way of working with them to get back to the best possible integration of this area of my body into my wider movement and life. I particularly enjoy working on this issue with women, and find it extremely rewarding. It can have profound effects.

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