What is the evidence for lymphatic massage (manual lymphatic drainage) postpartum?

Evidence for Lymphatic Massage Postpartum

Manual lymphatic drainage (MLD) has insufficient evidence to support its routine use in the postpartum period for most women, but may be beneficial for those who develop postpartum lymphedema, particularly after breast cancer treatment.

Postpartum Lymphatic Massage: Limited Evidence

The available evidence regarding lymphatic massage specifically for routine postpartum care is extremely limited. None of the major obstetric or postpartum care guidelines directly address lymphatic massage as a standard intervention for postpartum women.

Postpartum Uterine Massage (Different from Lymphatic Massage)

• Uterine massage is sometimes confused with lymphatic massage but serves a different purpose
• Recent research shows uterine massage after placental delivery can significantly reduce postpartum blood loss compared to controls (170.49 ± 61.46 ml vs. 186.20 ± 47.59 ml, p<0.05) 1
• Uterine massage focuses on contracting the uterus to prevent hemorrhage, not on lymphatic drainage

Lymphatic Massage for Specific Postpartum Conditions

Postpartum Lymphedema

• Complete decongestive therapy (CDT), which includes manual lymphatic drainage, is the standard of care for managing lymphedema 2
• For breast cancer survivors who develop lymphedema postpartum, MLD may be beneficial:
  • Significantly reduces excess limb volume (difference, d=71,95% CI=16-126, P=0.013)
  • Reduces dermal thickness in the upper arm (d=0.15,95% CI=0.12-0.29, P=0.03)
  • Improves quality of life measures including emotional function, dyspnea, and sleep disturbance 3

Components of Lymphedema Management

For women who develop postpartum lymphedema (particularly those with history of breast cancer treatment):

1. Manual Lymphatic Drainage (MLD):

   • Light pressure massage technique that assists lymphatic system function by promoting variations in interstitial pressures 4
   • Should be performed by trained therapists

2. Comprehensive Management:

   • Complete decongestive therapy (CDT) includes MLD, compression therapy, therapeutic exercises, skin care, and patient education 2
   • MLD and compression bandaging are considered equivalent in effectiveness for lymphedema management 2

Guidance for Clinical Practice

When to Consider Lymphatic Massage Postpartum:

1. For women with breast cancer-related lymphedema:

   • Refer to a lymphedema specialist (physical therapist, occupational therapist) 2
   • MLD should be part of a comprehensive treatment approach

2. For routine postpartum care:

   • No strong evidence supports the use of lymphatic massage for routine postpartum recovery
   • Standard postpartum care should focus on established interventions with proven benefits

Cautions and Contraindications:

• Lymphatic massage should be performed by trained professionals, especially in the postpartum period
• Women with active infection, thrombosis, or certain cardiovascular conditions should avoid lymphatic massage
• Aggressive massage techniques should be avoided in the immediate postpartum period

Conclusion

While lymphatic massage has demonstrated benefits for specific conditions like breast cancer-related lymphedema, there is insufficient evidence to recommend it as a routine intervention for all postpartum women. For those who develop lymphedema postpartum, especially related to breast cancer treatment, manual lymphatic drainage performed by trained professionals can be an effective component of comprehensive lymphedema management.