Does maternity massage have a safe and beneficial place in prenatal care to help deal with the discomforts and stresses of that long nine month marathon experience? Some would say, “No. You don’t want to do anything that might hurt the fetus.” But does massage during pregnancy have risks? Let’s explore these issues and find out what the benefits are and when massage during pregnancy might be a good idea.
Pregnancy is a wonderful time for most with the expectancy of new life. But with it comes many transitions and changes to the body. The majority of women who are experiencing a normal pregnancy may safely receive maternity massage, or some type of body like energy work throughout the entire pregnancy. In the first trimester be very cautious as this is the most vulnerable for miscarriage. If in doubt wait until your second trimester.
Maternity massage can be a good addition to your prenatal care to help you feel more comfortable during pregnancy and to get through it with less unwelcome symptoms. The exceptions would be if your pregnancy is high risk or you have any complications. (See below for precautions and warnings about maternity massage.)
One of the first benefits of maternity massage is relaxation. Pregnancy is a very stressful time for your body and mind. Relaxation during pregnancy and in preparation for labor makes it all go more positively.
Stress could contribute to some negative birth outcomes such as premature birth and low birth weight. Stress also contributes to increased maternal heart rate and blood pressure, miscarriage, gestational hypertension (bigh blood pressure), eclampsia, and fetal distress.
Your prenatal support could include maternity massage for stress, which can improve adaptation to all the overwhelming bodily changes. Even a single massage session can reduce the stress adrenal hormones such as cortisol.
Another benefit of maternity massage would be improved circulation of blood and interstitial fluids. This brings about better oxygen and carbon dioxide exchange improving nutrient flow to the fetus and yourself, along with better waste removal.
Although it goes mostly unnoticed by most women, you will have about a 40% increase in interstitial fluid volume during pregnancy and increased blood volume by 50% around week 34. Blood volume then declines somewhat before week 40.
A pregnant woman’s heart rate increases by 10 to 15 beats per minute. By the third trimester changes like edema with swollen ankles are a common occurrence. Studies indicate that Swedish massage andlymphatic drainage massage might decrease some of the negative effects of the increased blood circulation and fluid drainage that result in edema.
One of the significant changes as the fetus gets bigger is crowding of your organs, like the lungs. When the change in natural posture and structural alignment of the body starts to take place you might start to compensate with poor posture, shallow breathing and holding patterns that worsen the discomfort of the crowding. Maternity massage helps keep the body aligned, may improve breathing patterns and the strain on muscles. Besides massage, structural bodywork (Rolfing), active and passive stretches while being massaged, along with trigger point therapy could all be beneficial during your pregnancy.
Pregnancy brings about many changes to the skin, including stretch marks, dryness, itching and tautness over the abdomen. Massage to your skin is especially beneficial for healthy skin. It removes wastes and cleanses the skin. Skin stimulation also stimulates the brain, bringing about positive effects in the bodily systems of mother and baby. It also promotes production of hormones needed in pregnancy such as progesterone, estrogen, human placental lactogen and prolactin.
The compensation and strain on your torso muscles to make room for the growing fetus take their toll as the months progress. All of this strain causes pain, tightness and fatigue on the back muscles, especially the lumbar (lower back) as the weight of the fetus pulls your abdomen forward.
This shortens the muscles on the front of your hip, brings tension to the back of the hip, hyperextends the knees and adds more weight to the medial arches of your foot. All this also brings discomfort to the sacrum and iliac.
A hormone called “relaxin” relaxes the tendons and soft tissues to make space for the fetus. When the tendons, ligaments and fascia are in this relaxed state strains, sprains and joint instability becomes a problem contributing to discomfort and pain. Tightness and tension to muscles also contribute to such things as nerve compressions and night cramps.
An accumulating amount of research is showing that massage for pregnancy has a positive effect on all these symptoms. A massage therapist may help pregnant clients to manage, reduce and even prevent some of these unwelcome symptoms and discomforts of pregnancy.
A normal massage position is still okay until about the 5th month, or when the abdomen becomes larger than the pelvic girdle. After that, the most comfortable position for a maternity massage is the side lying position. This takes pressure off your abdomen. The therapist should use bolsters and pillows for support to help you to be comfortable throughout the massage. Semi-reclining and seated massage are also options.
Maternity massage sessions are a great time for you to practice relaxation and good breathing techniques. Breathing through muscle pain and restrictions during massage is a good preparation for labor. Relaxed, stress free, flexible muscles are better able to handle the demands of labor with comfort. It might be good to bring your partner to a massage session to learn some basic massage techniques to help you through labor.
Some massage therapists assist in labor massage at the hospital. If you have Braxton Hicks contractions, notice where you get tense and learn to breath and relax the muscles that tighten up. Ask your massage therapist to work on those areas in preparation for labor and to help you to facilitate relaxation through mind-body awareness. Labor massage would mostly consist of light massage for the back to relieve discomfort.
Light massage to the shoulders, arms and neck for relaxing and distraction from the pain of delivery could also be used. However, lying down for a long relaxing massage during labor could slow labor. Use a slightly brisk massage stroke and don’t stay in a reclining position for a long time. Walking and upright positions are best during labor. In general, massage and gentle touch during labor helps most women to cope better and relax.
Edema, particularly in the ankles and feet, is a normal result of prenatal circulatory and hormonal changes in many women, particularly with the constriction of the vessels in the pelvis. Generally this kind of edema responds well to massage, especially manual lymph drainage techniques, which is a very light rhythmic massage .
Some experts warn against any kind of deep pressure with any edema. If you have lymphodynamic edema caused y a dysfunction in the kidneys or any other organ due to a medical condition, or preeclampsia only light pressure is recommended. If you have little or no swelling you are safe with some deep tissue work as long as the other guidelines for the legs are still followed. Relief of muscular tension and soreness in the legs might just be what you need.
Many women do not have strong pelvic floor muscles. Since the perineum acts as support for the organs this becomes an issue, since pregnancy adds further strain. During labor and birth the perineum and connective tissues stretch a great deal. The perineum helps to guide the baby into position for delivery.
A well toned perineum is more likely to make labor easier and less likely to cause you postnatal problems, such as incontinence. Perineum massage can decrease the risk of tears and reduce the need for an episiotomy.
Perineum massage starting around weeks 34 -35 of your pregnancy is especially beneficial for first time mothers and those seeking to have a vaginal birth after a cesarean. All mothers could benefit from it though. Perineum massage helps you relax the pelvic floor muscles and stretch tissues in preparation for birth. It will give greater length, stretch and flexibility to the area during labor. Warm massage oil used in the massage would be helpful.
Perineum massage is outside the massage therapist’s legal scope of practice. The mother will have to learn to do it herself, or get the help of a mate or family member. For instructions about how to do perineum massage go to www.bellybelly.com
Pelvic floor exercises (Kegal) also help strengthen the perineum and expands the woman’s awareness of control of these muscles for birth. You will find information about Kegal exercises at the above link.
There are many conditions of pregnancy that could put you and your baby at risk during pregnancy and childbirth. While most can be managed successfully with the help of her physician, massage could increase the risk. If you have any complications in your pregnancy talk it over with your physician and get their okay before you get a massage. Make sure you find a massage therapist who is knowledgeable about how to safely give a maternity massage.
Here are some complications of pregnancy that should be taken into consideration before getting a massage during pregnancy. Discuss these conditions with your physician prior to scheduling a maternity massage:
• Pelvic or abdominal cramping and pain
• High blood pressure
• Swelling of hands, face or legs in 1st or 2nd trimester
• Pitting, systemic edema
• Vaginal bleeding or leaking of fluids
• Severe nausea or vomiting
• Severe headaches
• Swelling, pain, heat, or redness in legs
• Bulging, discolored or painful veins in legs, leg pain or swelling both legs
• Abnormal fetal heartbeat
• Lower back or inside thigh pain or pressure unrelieved by position or activity
• Mother’s age under 15 or over 40
• Any of the following - diabetes, cardiac, liver or renal disorders, chronic hypertension
• Asthma or pulmonary disorders
• RH negative blood type
• Drug exposure
• Genetic disorders
• Previous high risk pregnancy
• Multiple fetuses
• Placenta previa
Use Caution if you have:
• No prenatal care
• Obesity, eating disorders, or low weight gain
• Have a sexually transmitted disease
• Lifestyle risks such as smoking, drug or alcohol abuse
• Severe anemia
Relaxing, Swedish massage is OK during all trimesters, using general direct strokes toward the heart.
• 1st Trimester: avoid abdominal massage; risk of miscarriage is highest
• 2nd and 3rd Trimesters: only light abdominal massage strokes (effleurage) should be used, skin deep only
Pregnancy brings about increased chances of blood clots and varicose veins to your legs due to a higher level of estrogen and progesterone. Most pregnant women will get them, but they will cause no major threat unless they dislodge and circulate. Thrombophlebitis, deep vein thrombosis and blood stagnation could become a problem. It should be assumed that all pregnant women might have a clot in their leg and the following should not be done:
• Deep or sustained pressure to the pelvis or groin area.
• Use only superficial or broad area pressure throughout the medial (inside) surface of the legs.
• Deeper pressure on the lateral (outside of) leg is okay.
• Do not allow deep or pointed pressure or compression to these areas.
• Do not have leg massage if you are high risk for these problems.
• Use light pressure over varicose veins.
Avoid acupressure, cross-fiber friction, deep tissue, trigger points or any deep ischemic pressure to the medial (inside of) leg. Circulatory leg massage should not be done if you are on bed rest.
Reflexology: Avoid points for the uterus and ovaries. Caution should be used around endocrine gland points.
Acupressure: Avoid pressure of meridian points for the spleen 6, kidney 3, bladder 60, 67, and 31-34. Also for the large intestine 4, gall bladder 21 and liver 3.
There are some movements (active and passive) that you and your massage therapist should be careful of. Avoid rocking movements during the first trimester as this can cause nausea. During the second and third trimesters use caution with hips and legs if there is strain or separation of the symphysis pubis joint. During all trimesters you should avoid hyper-extending your joints (bending too far the wrong way).
Even under normal conditions pregnancy is like a long, hard marathon for both of you! Take advantage of maternity massage therapy until the end results are finally in hand.
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