921981665_041356a2ebPrenatal massage can be a wonderful way to help your clients reduce stress, relieve headaches, and improve sleep during pregnancy. Many pregnant women suffer from these kinds of discomforts along with hormonal changes, anxiety and back pain.

According to prenatal massage therapy pro Anne Heckheimer, one of the key differences between prenatal and regular massage therapy is the positioning. She says “As a prenatal massage therapist, you have to learn to position your clients with pillows, cushions and bolsters so that your clients will be extremely comfortable.”

In this article we’ll explain some of the common concerns and questions that your clients may have about prenatal or pregnancy massage.

Is it safe?

We discussed this common massage myth previously on our blog and the answer is… Yes, massage is safe during pregnancy.

Alissa Haines wrote about this pervasive massage myth:

Women have been massaging each other through pregnancies for thousands of years, so when did this rumor start?

My best guess is that this myth came from fear and concerns about liability. If a pregnancy is going to spontaneously terminate, it is most likely to happen in the first twelve weeks of pregnancy. This means there is an increased chance of a massage being administered and miscarriage occurring in the same small time frame, say a few days. But we’re smart massage therapists. We know that correlation does not imply causation. A miscarriage may be caused by any of several issues including chromosomal abnormalities, severe chronic illness or severe trauma. The application of skilled massage is not a cause of miscarriage.

When someone asks you about safety of massage at any point in pregnancy, refer them to a professional with advanced training in this area.

Benefits

There are several small studies that have focused on massage in pregnancy. One study at the University of Miami School of Medicine suggests that massage therapy might have multiple positive effects, including:

  • Reduced anxiety
  • Improved mood
  • Better sleep
  • Less back pain
  • Decreased levels of stress hormone

In another study of pregnancy massage in depressed women, researchers found:

  • Increased levels of the “feel-good” hormones serotonin and dopamine
  • Decreased levels of cortisol, an indicator of stress
  • An overall improvement in mood

Pregnancy Massage Tables

There are fancy massage tables made just for prenatal massage use, but many therapists prefer to use a sidelying position for a few reasons.

Jules Moon, a prenatal massage therapist in Portland, gives her reasons for not using a “pregnancy massage table” in her practice:

My reasons have to do with the mechanics of the spine and abdomen. Pregnancy massage tables are only able to be customized to a certain degree, which means you will likely be lying over a hole that’s too wide, too narrow, too deep or too shallow for your body at any given stage in your pregnancy. Essentially, while lying face-down, there are two situations:

1.  The gap is loose and does not apply pressure on your belly, but the weight of your uterus will be pulling your abdomen into the hole, increasing the curve of your lumbar spine and adding to the stress on your sacral and uterine ligaments. This effect is increased even further if a massage therapist were to press down, working the muscles of your lower back. Pregnancy already creates a tendency toward increased spinal curvature and ligament tension; this is quite likely one reason you’d like a massage right now, and I would much rather help alleviate that discomfort, instead of compounding it.

2.  Your belly and spine are well supported, but the trade-off is that the weight of your body and any added pressure from a massage therapist’s hands are translated directly into compressing your abdomen and uterus.

Moon writes that she prefers “the sidelying position on my extra-wide massage table,” along with various sized pillows for support of the spine and pelvis.

Sensitive Pressure Points

It is important to be aware of sensitive pressure points on the ankles and wrists that can stimulate the pelvic muscles, including the uterus. The American Pregnancy Association advises pregnant women who have experienced pre-term contractions to alert their therapist to the fact that these pressure points should be avoided completely. Your client should consult with her health care provider prior to massage, especially if she has any high-risk conditions or serious symptoms such as severe swelling or sudden, severe headaches.

[UPDATE: I’d like to respond to the idea mentioned above of dangerous pressure points. I’m author of Nurturing Massage for Pregnancy: A Practical Guide to Bodywork for the Perinatal Cycle, and developer/instructor of the 60 hour MotherTouch Maternity Massage Certification since 1992. I am also former labor and delivery nurse, doula, and childbirth educator. I can say with assurance, there are no “points on the ankles and wrists that induce labor”. Please be aware that this is a myth! THe primary points of concern are on the webbing of the hand between thumb and first finger (LI-4), and 4 fingers superior to the medial ankle (SP-6). These points are often contraindicated for ACUPRESSURE not massage–Acupressure may be of concern when used intentionally with sustained deep pressure in conjunction with other acupressure points that balance the energies and hormones of the body. Massage to these areas is not an issue. —  Leslie Stager

Thanks for the clarification on this point, Leslie!]   

 

Certifications

Advanced certification is not a requirement in most areas, but it is recommended, according to the American Massage Therapy Association. “Most massage therapists who want to specialize in this work very quickly find their marketing is much easier if they are thoroughly educated,” suggests Carole Osborne, author of Pre- and Perinatal Massage Therapy, now in its second edition. “A woman’s body goes through many, many adaptations during pregnancy on every body level, not to mention their emotions. These changes have significant ramifications for how we can most safely and effectively support these clients.”

If you’re interested in advanced training and certification in this specialty there are many on-site, correspondence, and online training courses available. Here are just a few:

AMTA education calendar – on-site courses

Body Therapy Associates – specializes in pregnancy massage

Institute of Somatic Therapy – correspondence and online certifications

Update: This post has sparked some outstanding discussion over on LinkedIn (via the ABMP LinkedIn group). Go have a look to see what others are saying or post your comments below!

Comments from original Massamio post:

Thanks for this thoughtful post. I second the concerns about cutout pregnancy tables. I studied with Carole Osborne, and these are all good guidelines. — Posted @ Monday, April 01, 2013 7:31 PM by Tracy Walton

I also highly recommend the Body Support cushion system for therapists doing a lot of perinatal massage. It can make a pregnant woman able to safely and comfortably be positioned prone and supine through most of her pregnancy, although in the third trimester sidelying is still probably safest for most women and their babies. — Posted @ Tuesday, April 02, 2013 9:36 AM by Sarah Mullinger

Thanks, Tracy & Sarah for letting us know it’s accurate information. — Posted @ Tuesday, April 02, 2013 12:41 PM by Benjamin McDonald

I don’t think that the therapists are necessarily afraid to perform prenatal massage in the first trimester, I think the issue is that heaven forbid the client suffered a miscarriage the client would be thinking ‘what happened, what went wrong, what did I do, was it the massage, etc.’ Women will question why this happened to them and potentially place blame even if there is no legitimate reason. — Posted @ Tuesday, April 02, 2013 5:18 PM by Cheryl Baisley

I love my Side-Lying Positioning System. My pregnant clients tell me it is very comfortable and wish they had it at home. — Posted @ Friday, April 05, 2013 6:53 PM by Tracy

I’m curious to gauge people’s thoughts – since I have had 5 pregnancies and 4 births, and doula training, I’m inclined to think I might not necessarily need to get certified for pregnancy massage to be able to provide massages to them – my body so remembers what positions were painful or relaxing, what area needed to be touched etc. Ofcourse probabaly body to body have differences, and it’s always good to be educated so it’s under my radar, and I just received my license so am not going out to sell myself for pregnancy massage therapist quite yet. But am curious to hear what other experienced LMTs running ahead think of this situation. — Posted @ Monday, April 08, 2013 12:30 PM by Mitsco

Hi Mitsco, Thanks for asking the question. It’s a good one. I’d love to hear other peoples thoughts. Mikki Anderson commented on the Massage Learning Network that “it is the education that makes the difference in the effectiveness and the safety for the mom and her precious cargo…WIth all due respect to Utube, nothing compares with taking a full prenatal training.” No doubt, your experience goes far beyon “Utube” however. What do others think about this question? — Posted @ Wednesday, April 10, 2013 12:58 PM by Benjamin McDonald

I agree with Sarah in that the bodyCushion is excellent for prone and side lying pregnancy massage, and I use it all the time in my practice.  With regards to Mitsco question, in the UK you can only get insurance for what you have been taught, so if you haven’t been taught and got the certificate for pregnancy massage then you wouldn’t be able to work. — Posted @ Saturday, April 13, 2013 3:04 AM by Paula Kemp (Pregnancy Massage)

I have been therapist for 18 years and have always done prenatal massage side line, and all of the above is true. Women need to take a load off and get pampered like they need during this delicate time. Mainly low back pain, just stay away from first trimester and last, no deep work on hands and feet, and all is good to go!! — Posted @ Saturday, April 13, 2013 1:32 PM by Yolanda Tamez

I’d like to respond to the idea mentioned above of dangerous pressure points. I’m author of Nurturing Massage for Pregnancy: A Practical Guide to Bodywork for the Perinatal Cycle, and developer/instructor of the 60 hour MotherTouch Maternity Massage Certification since 1992. I am also former labor and delivery nurse, doula, and childbirth educator. I can say with assurance, there are no “points on the ankles and wrists that induce labor”. Please be aware that this is a myth! THe primary points of concern are on the webbing of the hand between thumb and first finger (LI-4)<not wrist>, and 4 fingers superior to the medial ankle (SP-6)<not on ankle!>. These points are often contraindicated for ACUPRESSURE not massage–Acupressure may be of concern when used intentionally with sustained deep pressure in conjunction with other acupressure points that balance the energies and hormones of the body. Massage to these areas is not an issue. <For more details, you can read my article about it in Massage & Bodywork Magazine: http://massagebodywork.idigitaledition.com/issues/8/66>  — Posted @ Sunday, April 28, 2013 1:34 AM by Leslie Stager

Certification lets your clients know your level of commitment and training. Being pregnant gives you compassionate understanding of your pregnant clients, but it does not teach you common pregnancy, labor, postpartum risks to know as a bodyworker, or teach you preventative body mechanics for working in sidelying positioning. In advanced trainings you should learn proper positioning for maximum safety, comfort, and alignment in sidelying and semi-reclining positions; ways of realigning pelvis pregnancy through motherhood; how to deal with perinatal clients who all have 5x greater risks of blood clots than normal clients. You should learn why, when, how you might position prone, supine, or semireclining. In my trainings you learn breast massage, balancing the pelvic floor and working adductor and rotator attachments at pubic ramus. You learn birth massage techniques, and how to work with freshly postpartum mothers. There are only a few certification programs available… Find one that is very comprehensive. Becoming certified shows you have more advanced knowledge about pregnant clients than 90% of other practitioners. These equals more business, more respect from those who refer to you, and from your community at large. — Posted @ Sunday, April 28, 2013 1:42 AM by Leslie Stager

Great points Leslie, thanks for your insight regarding education and certifications which prepares us for any major complications and “providing work” vs. experiencing being on the receiving side.   You convinced me I should get some good training before taking in pregnant clients.  Regards – — Posted @ Sunday, April 28, 2013 2:02 AM by Mitsco

Thanks everyone for the excellent comments. Based on some of the discussion, we have updated this post. Thanks especially to Leslie Stager for sharing her knowledge on the subject. — Posted @ Friday, May 10, 2013 11:35 AM by Benjamin McDonald