June 30, 2021

Kristin talks with Megan Michelotti CD (DONA) about the lymph system and manual lymphatic drainage (MLD) and how it can be helpful prenatally as well as postpartum.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin: I’m Kristin, co-host of Ask the Doulas with Gold Coast Doulas, and I’m joined today by my dear friend Megan with GR Birth and Wellness.  Welcome!

Megan:  Hi, Kristin!  Thanks for having me!

Kristin:  So I’d love to have you tell our listeners a bit about your business, what you do, and, of course, our focus today is on some of your massage-specific services.  But I’d love to chat about your journey, since you and I started out as doulas about the same time.

Megan:  Yeah.  It seems like forever ago now.

Kristin:  Yes!

Megan:  It’s amazing when you kind of take inventory of that time.  Yeah, my background is in birth work.  I’ve been a doula for going on eight years.  I’m into my eighth year.  And did some placenta encapsulation for a few years, and got into massage largely because of my work in placenta encapsulation and being more a part of that postpartum period and getting really passionate about health and planning for health, mental and physical, in the postpartum period.  So it transitioned really nicely into massage.  Massage is something I’ve been a lifelong consumer of.  I say consumer, but it’s really, like, completely obsessed.  It’s my job to get massage, frankly.  So I’m always chasing my next massage appointment.

Kristin:  It’s so good for you, so it makes sense.

Megan:  So, yeah.  I am focusing still on the childbearing year.  It’s funny that people come to me, like, oh, do you do prenatal massage, and I think, yeah, I totally work on pregnant women, even though my heart, again, like I said, was led to massage really through a passion for the postpartum period.

Kristin:  Yeah, and with placenta encapsulation, you do get to see your clients in a raw and vulnerable way, and we realize, you know, when we added postpartum support to Gold Coast, like, how it is lacking.  And women are just feeling overwhelmed, and the focus on traditional healing is not where it needs to be in the US, in my opinion.  So some of the services you provide to get them back to the warm state after being in the cold state and delivery is so essential.  Postpartum massage, and I know that you have a passion for the manual lymphatic drainage service, especially for women who are recovering from a Cesarean birth.  So I’d love our listeners to learn more about the benefits of lymphatic drainage and how you work with them, what it’s like.  If you can paint a picture for us, that would be great, Megan.

Megan:  Sure.  It’s really interesting how I stumbled upon this.  An answer to some questions, actually; some health issues I had from long before I went to school for massage therapy.  But I took a certification program.  That was – I want to say it was – I can’t remember how many hours it was, but it was broken up into a couple days.  I want to say it was, like, seven different two-day courses.  So I took that in conjunction with my licensure prep.  And one of the two-day breakouts was Mommy and Me MLD.  And I was like, ooh, what do we have going on here, because here I’m learning about this awesome therapy that is highly utilized in the plastic surgery community.  It’s getting more utilized within the NFL because of the focus there on the concussions.  And I’m learning about the use on horses, like high-performance animals, and just bodies that are needed to recover quickly and perform.  And all of a sudden, we have Mommy and Me MLD.  And I’m thinking…

Kristin:  It’s perfect!

Megan:  How does this get into these other formats of using this therapy?  So I was the first person at class that day.  And I just was blown away by all the questions and things that don’t make sense and things we just don’t have an answer for that we do.  We do have an answer for it.  It’s largely the lymph system, while in pregnancy, with healing in pregnancy, breastfeeding in postpartum – the lymph system is integral to all of those things, and we learn not performing at our highest, which we aren’t during pregnancy.  The lymph system is taxed during pregnancy and in the postpartum period.  So we’re asking it to do so much at its most vulnerable.  So lymphatic drainage really helps optimize that system to make all of those little steps along the way a little bit easier.

Kristin:  Now, for a client who has a planned Cesarean birth, is it beneficial to get work done pre-surgery and then schedule post-surgery, or how does that work?

Megan: To get the most benefit out of the therapy, the protocol, the recommendation, is definitely before and after.  But either/or is also beneficial.  Because we’re talking about optimizing a system that naturally works with our body, there’s not really a wrong way to do it.  I mean, barring contraindications.  But generally speaking, if you can plan to do a series of three before surgery, you’re getting your lymph system really up and running, and you’re increasing white blood cell count, and you’re increasing the system and getting it all ready to clean up the humongous trauma that it’s about to have.  And I mean the specifically physical trauma of what happens during surgery.  To then revisit afterwards and keep the lymph system up and running is going to help further as you begin healing.  But, again, before or after is optimizing the system to meet that adversity.

Kristin:  And how long after a scheduled birth?  I mean, obviously, there’s that six weeks of healing.  When do you recommend a client come in to see you?

Megan:  So, 40 to 72 hours.  The main thing is that we just want someone who has undergone surgery to be stable, right?  So we’re taking a system that works relatively slowly and we’re bringing it up to ten times its normal speed.  So we don’t want to send this system whose job it is to clean out everything, to send all the waste products at organs that are not stable.  So after a surgery, 48 to 72 hours, and I like to get a doctor’s note, just because of that.  But yeah, that’s the window where you can start, and that’s a lot of times where swelling starts to be at its worst, too, after a Cesarean.  So it kind of works out well that way.

Kristin:  Yeah, that makes a lot of sense.  And I know I’ve seen you post on social media about having even baby with mom during the massage or lymphatic drainage.  Is that something that you are still doing, if their partner is back at work already and they want to see you?

Megan:  Yeah, absolutely.  I do mobile massage.  I try to keep my practice very diverse so I don’t even get bored.  So I do work in my studio, and then I also have some mobile clients.  But either way, because I have my background in doula work, I assume that babies are going to be with new mothers.  Right?  And that’s not necessarily something that a lot of our culture and society thinks about when we’re sending moms to certain appointments after a baby is born and having expectations after a baby is born.  So stunningly, some babies are real cooperative, and I’ve been doing MLD weekly with a post-Cesarean mom for five weeks now, and I’ve never seen – her baby is always sleeping when I’m there.  It’s always amazing.

Kristin:  Must be the atmosphere that you have set up.  The low lights, the music – chill for the baby.

Megan:  But for the most part, I’m assuming that there will be a baby, and frankly, for moms who are breastfeeding, I’m assuming there will be breasts around.  So with my background, that’s my norm to be around new moms with their babies in their natural state, and to come to them and be a tool that is working around their world in that time and not asking them to do something that’s, frankly, unreasonable, immediately postpartum or even in that first month, really, after baby.

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Kristin:  And you mentioned one client that you’re working with who’s five weeks in.  What is the typical length to really see improvement?  Is it based on the client and their health, or how does that work?

Megan:  So it’s relative to kind of where you’re starting out.  So if we can backtrack and just do a little education, the lymph system is the width of a human hair.  It’s a really tiny system, and it sits between your skin and muscular system.  So it’s a very delicate system, and it doesn’t have much room as it is.  When you’re pregnant and gaining what’s considered the normal, healthy, 20 to 30-ish pounds during nine months, that’s still considered a rapid weight gain, and your adipose tissue is fighting for that space and really taxing the space that the lymph system already has.  And that’s why we see more swelling and more fluid retention in pregnancy.  Additionally, as your belly gets bigger and it’s compressing the cisterna chyli, which is a main lymph drain kind of right in the center of your body, baby is compressing that.  If you’re working in a job where you’re sitting and your belly is sitting kind of over onto your groin and you’re compressing into all the lymph nodes in your groin, huge filtration going on there, and that’s taxed, then, when you have a belly that’s sitting on that very delicate system.  So some women’s lymph systems are up to this job of doing this, and if you’re moving more, you know, the lymph is moving on your muscular movement, so if you’re moving more and you’re drinking a lot of water, then your lymph system is already optimized, right?  You’re already doing what you need to be doing to keep it going, and maybe it can handle what your body is producing and you don’t see a lot of swelling.  So depending on where you are or where your baseline is, it depends on what kind of “results” you’re going to see, and I use those terms, you know, just for the sake of an understanding, but it’s hard to see, right?  It is a system that you can’t see, and if it’s already optimized and you optimize it more, you might not see results.  But it’s clinically noted and it is happening, and the results are truly amazing.  But when you do have a lot of swelling, results are very obvious and pretty quick, because we’re taking a system that runs about 10 to 12 beats per minute – we’re taking that up to ten times that.  So you’re taking something that’s moving very slowly and moving it very quickly.

Kristin:  So it sounds like your touch is very gentle with this procedure versus regular massage, then?  What would a woman expect to feel?

Megan:  Right.  So I’m really careful not to call it lymph massage, which a lot of – I see that a lot of places.  I don’t even like to use the word massage with lymphatic –

Kristin:  So MLD or manual lymphatic drainage?

Megan:  Yeah, or just calling it lymphatic therapy, because if someone has it in their mind that they’re going to get a massage, they will be quite disappointed.

Kristin:  Different technique.

Megan:  It’s a completely different technique.  We use the weight of a nickel.  We don’t want to crash past the lymph system into the muscular system, which is where you get those great feelings of traditional massage is getting into that muscle and softening.  So we’re really moving skin.  It’s a very light touch, and we’re trying to move the lymph through that system, like I said, that’s just between the skin and the muscle.  So it is light touch, and it’s done in a way kind of – like if you picture this system, it has valves going both ways, so it’s not like your vascular system.  So you work from right to left, and then you work back left to right.  You work from up to down, and then you work again going down to up.  So it has two-way valves, and the system moves the lymph kind of like if you can imagine batting a balloon.  So it moves kind of like that, just slowly, puff, puff, puff, and then as you move the skin, those valves are forced to open more forcefully and stay open a little longer and then close.  You’re patting that balloon forward, if you will, those little sections of lymph.  So it’s a really different therapy.  It’s a very specific protocol where when I’m doing traditional massage, I’m kind of just letting my hands feel what I can and I let the body kind of guide me.  Where manual lymphatic drainage, the protocol is very specific, and it’s going to be the same protocol every time.

Kristin:  It sounds like when you had mentioned swelling, I’m guessing – I mean, obviously, it’s great for post-Cesarean clients, but if someone had a lot of swelling – say they had preeclampsia and had swollen ankles and had an IV.  Is that – are you seeing any clients with other issues that they’re trying to heal from?

Megan: Specifically, preeclampsia would be a contraindication because it does deal with high blood pressure.

Kristin:  Say a client was on an IV for an extended time, had a lot of fluids, and had preeclampsia.  They’re back to normal health after delivering baby, and they’re still seeing a bit of swelling.  Their blood pressure has normalized.  Is that a condition, or even just general IV fluids or general swelling that is taking its time to work itself out?

Megan:  Yeah, definitely.  Again, especially after Cesarean, where the incision is made goes directly across two main highways that connect your axillary drains, which are in your armpits, and your inguinal drains, which are in your groin.  So if you can kind of draw an imaginary line from your armpits to both sides of your pubic bone, those are main, main highways where your lymph system is getting a lot of efficient movement, and when you make an incision for a Cesarean, you are cutting right through that system.  And a surgeon repairs many, many layers, but they don’t repair the lymph system.  That lymph system is damaged for life.  And the lymph system is great.  It’s a beautiful system.  It’s made as part of our human body that orchestrates so perfectly.  So the lymph system finds another way.  It’s not like oh, lymph is going to sit there for ever more.  It’s a broken chain.  The lymph will find its way into lesser-used highways, if you will, but that is a really big highway that they just shut down, and it will be taxed for life.  So that is one issue when it comes to Cesarean.  Two, you’re not moving a lot after you have a Cesarean.  Again, the lymph system moves on muscle movement, so when you’re not moving much, again, your lymph system is not doing the best it could.  It’s also trying to heal you, so its focus is on getting white blood cells and your immune system fighting off infection.  It’s not necessarily focused on just moving out all the stuff that was pumped into you.  So it’s just got a lot of jobs after a surgery, and again, it’s at its most vulnerable.

Kristin:  That makes sense.  How long is an average session?  Is it similar to the length of a massage?

Megan:  Yeah.  You can kind of just decide how many passes you want to do.  So the protocol is to open the main drains and then kind of move up every limb toward the drain and move along those main highways, and you can do 10 passes or you can do 30 passes.  Sometimes I’ll add a mini lymph into some of my clients who are there for traditional massage if they mention swelling.  I might say, you know, do you want to try that?  We can do that for 20 minutes of your hour.  So you can do it at whatever rate you would like to, but generally speaking, yeah, just an hour treatment is what I would consider normal in a series before or after surgery.

Kristin:  That makes sense.  So do you have any other tips or advice for our listeners who are either preparing themselves for the postpartum phase or are already in that phase of healing?

Megan:  Well, I have all kinds of great tips.  The lymph system, it’s so amazing to me.  I just get so fired up and passionate about it because, again, it answered some questions for me about some things that I had experienced, but it’s truly one of these things where, for instance, we hear all the time, make sure you drink enough water.  Your body is 98% water.  Drink your water.  Drink your water.  But then when you really focus in and research and learn why and you learn how important it is for your lymph to flow through this tiny system – drink your water!  I can’t underscore that enough.

Kristin:  Especially with breastfeeding.

Megan:  And with breastfeeding, your system is competing with even more things competing for space.  When you have your system when your milk comes in, all those ducts and that whole system is also competing with some of your main lymph drains under your armpits and under the breast tissue.  So that’s where that comes into play with breastfeeding.  A lot of the things that are just normal – like, we know what to do to keep ourselves healthy.  Those are the things that will keep the lymph system healthy: movement, drinking water, deep breathing.  It’s an influx of oxygen and helps move the lymph system.  So all good tips there, but here’s my other tip, and my kids will echo this a lot: don’t wear underwear and bras to bed!  Your bra and underwear cuts off your  main lymph drain highways.  So as they get tighter through pregnancy and you’re like, oh, I’m not going to buy a bunch of new underwear and bras; it’s temporary.  They are compressing it even further, and even in people who are not pregnant, it’s a great time to let your lymph system breathe.  So my kids and my family does not wear underwear and bras to bed because we love our lymph systems.  So those are my great tips about the lymph system and keeping it optimized as best you can.

Kristin:  What about, since you mentioned bras, what about someone who just sleeps and pretty much lives in different nursing tanks?  Is that a different kind of pressure, or what do you advise for that?

Megan:  Well, I understand that for many of us, bras are a necessary evil.  So just being aware of where it’s hitting you and how tight it is, you know.  So if you’re wearing compression, like a tank, that’s great.  You’re not hitting across that – pretty much right where your band of a traditional bra would be is the main lymph highway around your back.  So trying to have it hit a little lower like with even a sports bra that’s not super tight or a tank is going to be more helpful.

Kristin:  And then how do our listeners find an MLD therapist in other areas?  You’re our go-to expert in West Michigan, but is there a directory, or how does one search?

Megan:  You know, that is a great question.  I mean, it’s not a very regulated certification, so there’s many different certifications for MLD.  It can be a little hard on the consumer that way, like anything that’s not well-regulated, but I would say a Google search is going to reveal some practitioners, and then asking those practitioners where they were certified, what their certification program was like, just their knowledge and their foundation, will give you some more information about what kind of lymph therapy they’re getting into.  I think it’s important to note, too, there are some other kinds of lymph therapy that I’m not exactly familiar with.  There are people who are expecting a very painful protocol, so there are some practices out there that people have experienced that are not my knowledge of lymph therapy, and that’s something that I always clarify with my clients, expectations versus reality, and that’s something we cover ahead of time.  What’s your familiarity with this therapy?  What are you expecting?  Here’s what I’m actually doing.  Especially from outside of the US, I’ve heard some really interesting stories about really, really painful lymph work, and like I said, I’m not familiar with exactly what these people experienced, but it just can’t be further from how I would describe what I do.  It’s such a gentle, light touch therapy.  So just asking follow up questions of the practitioner of what exactly are they practicing and who their certification was through, I think, would be – I mean, just like hiring any practitioner.

Kristin:  Yeah, like hiring a doula, the kind of questions you ask, yeah.

Megan:  Right.  Exactly.

Kristin:  How were you trained?  Are you certified?  Yeah, those type of questions.  Do you have insurance?  So, Megan, how do we find you?  What are the best channels?  How can our clients or listeners reach out to you if they’re located in West Michigan?

Megan:  Well, you can always find me with GR Birth and Wellness, and then I also have MLD Therapy of Grand Rapids, so I market it as a completely separate business, again, to really kind of fight against that unmet expectations.  It’s really so separate from what I consider to be traditional massage and what the consumer is thinking.  So I have the completely separate MLD Therapy of Grand Rapids.

Kristin:  Can you give us both of those websites, then?

Megan:  You can find me at GR Birth and Wellness, as well as MLD Therapy of GR.

Kristin:  Well, thanks so much!  You’ve educated me and I’m sure many of our listeners will look into this more, because it isn’t something that’s talked about.  I’m so glad you brought this topic up in our local doula group and that we had the opportunity to dive into it.

Megan:  Thanks so much!  I love talking about it.  I hope you can tell!

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