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May 2013

Prenatal Massage Therapy

Massage Therapy has become a highly sought after form of relief for common pregnancy related aches and pains.  In a 1994 survey of prenatal massage therapists, the primary focus of their clients was to seek relief from aches and pains associated with their pregnancy.  According to a Swedish study, 48-56% of all pregnant women experience backache during pregnancy, describing their discomforts as generalized fatigue, tightness, and achiness, with concentrated areas of pain.  The most common complaint areas include discomfort in the sacroiliac area, lower back, and upper back.  Many women report their first occurrence of chronic pelvic and back pain during 5-9 months of pregnancy.  Women who receive frequent massage during pregnancy have reported better sleep, improved moods, and fewer complications with labor and birth.

WHAT IS A PRENATAL MASSAGE?

Pregnancy related pain is the result of improper posture created by the anterior weight load of enlarging breasts, uterus, and fetus, muscle strain and imbalance, fetal positioning, hormonal effects on ligaments, and referred pain from uterus ligaments.  Therapeutic massage and bodywork helps to support the psychological, physical, and structural well-being of a woman who is pregnant, laboring and/or postpartum.  A prenatal massage uses various techniques including circulatory, deep tissue, neuromuscular, passive and active movements, and reflexology, among other modalities.  In a typical prenatal massage session, the trained therapist will address the woman’s physical challenges, such as areas of pain and postural and functional changes.  During a massage, many women can experience a release of hormones that provides a stress-reducing effect.  Massage can help improve uterine blood supply and relax the mother, as well as maximize optimal fetal and maternal outcomes.  Some therapists are also trained to provide sensory awareness to the mother through massage that will help her to labor more comfortably and actively.

IS MASSAGE SAFE DURING PREGNANCY?

Prenatal massage is specifically tailored to meet the physical and emotional needs of each individual pregnant woman.  Women can begin massage therapy at any point in pregnancy and continue until the birth of the baby.  Some massage practitioners may be uncomfortable doing prenatal massage with women who are still in their first trimester because of morning sickness or the increased statistics for miscarriage.  However, massage during pregnancy is not only safe, but can be very beneficial for the mother and baby during the first few weeks of pregnancy for a healthy, low-risk woman.

Prenatal massage practitioners should be trained and, preferably, certified in prenatal massage therapy.  They should also be knowledgeable about normal prenatal and perinatal physiology, high risk factors, and complications of pregnancy.  To safely massage pregnant and laboring women, some pregnancy related conditions require adaptations and, possibly, a consultation with the client’s care provider prior to receiving massage.  Depending on the individual and the trimester of pregnancy, various techniques and methodologies must be modified or eliminated.

During the massage, mild to firm pressure is applied to the muscles throughout the body to address the discomforts associated with the skeletal and muscular changes brought on by the hormone shifts during pregnancy.  A professionally trained prenatal massage therapist should be aware of specific pressure points to avoid that may cause pre-term labor.  In addition, there are pregnancy related conditions that are contraindicated for prenatal massage that your therapist should be aware of.  These include high-risk pregnancy, pregnancy induced hypertension, pre-eclampsia, previous pre-term labor, severe swelling or edema, high blood pressure, and severe headaches.

WHAT ARE THE BENEFITS OF MASSAGE DURING PREGNANCY?

Effective massage therapy sessions can not only help a mother physically, but emotionally support her as well.  Physical and emotional support, including extensive touching and massage, can reduce the length of labor and number of complications, interventions, medications, and Cesareans at birth.

Prenatal massage has been shown to reduce anxiety, decrease symptoms of depression, relieve muscle aches and joint pains, and improve lymph and blood circulation.  Other potential benefits include: reduced back pain, reduced edema, reduced muscle tension, improved oxygenation of soft tissues and muscles, and better sleep.  Sciatic nerve pain can be caused by the added pressure of the uterus on the pelvic floor.  Many women experience significant reduction in sciatic nerve pain with regular massage during pregnancy.  Massage therapy can also address the inflamed nerves by helping to release tension on the nearby muscles.

Recent studies have shown that hormones, such as norepinephrine and cortisol (the stress hormone) were reduced and dopamine and serotonin levels were increased in women who received massage bi-weekly during pregnancy.  These changes in hormone levels can lead to fewer complications during birth and fewer instances of complications with the newborn.

Massage can help to stimulate soft tissues to reduce collection of fluids in joints, which improves the removal of tissue waste through the lymph system.  This can reduce the occurrence of edema that is often caused by reduced circulation and increased pressure from the uterus on major blood vessels.

According to a study done on maternal behavior in mammals as noted in the October 2010 edition of Massage Magazine, “Scientists found lack of cutaneous stimulation had far-reaching effects.  Pregnant rats restricted from licking their abdomens and teats had poorly developed placentas and 50% less mammary gland development.  Their litters were often ill, stillborn or died shortly after birth, in part due to poor mothering skills.”

Women who are reassuringly touched during labor for at least 5-10 seconds have a decrease in anxiety and blood pressure.  Women showed improved moods and less pain and anxiety when massaged by their partner over their head, back, hands and feet for 20 minutes per hour during labor.

WHY IS POSITIONING DURING A PRENATAL MASSAGE IMPORTANT?

During the first trimester of pregnancy, many women are able to comfortably lay in a prone or face down position while receiving a massage.  However, it is still necessary to use precaution and adapt to her comfort during this period.  After the first 13 weeks, it is safest and most appropriate to position a woman side-lying.

Lying supine or face up also involves safety considerations while pregnant, because of the added weight the baby presents to the inferior vena cava.  Extended compression to the vena cava can result in low maternal blood pressure and decreased maternal and fetal circulation, especially with a posterior positioned placenta.  It is safest to elevate the torso to a semi-reclined angle of 45° – 75° after 13 weeks.

Side lying is the most ideal and safest position for prenatal massage to avoid pressure to the vena cava and prevent strain on the lumbar, pelvic, uterine and musculoskeletal structures after the first trimester.  It also prevents increased intrauterine pressure and increased pressure to the sinus cavities.  The left side lying position allows maximum maternal cardiac functioning and fetal oxygenation.  Pillows and bolsters are used to support the expectant mother and baby for an experience of ultimate comfort and relaxation.  While in a side lying position, a woman often feels safest and psychologically at ease, able to voice her excitement, concerns or fears about the pregnancy and upcoming birth.

HOW TO FIND A PRENATAL MASSAGE THERAPIST

Most massage therapy training institutions teach massage therapy for women who are pregnant; however, it is best to find a massage therapist who is certified in prenatal massage. Organizations such as the American Massage Therapy Association, Associated Massage & Bodywork Professionals, and National Certification Board for Theraputic Massage and Bodywork are great places to find experienced and professional massage therapists that are certified in prenatal massage. Referrals and recommendations from friends, family and birth professionals is another way to find a qualified prenatal massage therapist. When searching, some good questions to ask him or her are: what kind of training does he/she have, how long has he/she been in practice and does he/she specialize in prenatal massage.

http://www.amtamassage.org/articles/3/MTJ/detail/2419

http://www.bodytherapyassociates.com/articles/MaternityMTspecialization.pdf?id=11727

http://www.bodytherapyassociates.com/articles/positioning.php

http://www.bodytherapyassociates.com/articles/articles.php

http://www.bodytherapyassociates.com/articles/pregnantpelvis.php

http://www.pghhealthandhealing.com

http://americanpregnancy.org


 
Hannah Reasoner, LMT graduated from White River School of Massage in Fayetteville, AR in 2005. She has over 750 hours of massage and bodywork training, including nearly 75 hours of advanced training in prenatal and postpartum massage. Throughout her career, Hannah has worked closely with chiropractors, doulas, midwives, childbirth educators and other birth professionals. Hannah serves a majority of prenatal, laboring, and postpartum clients in her private practice in Fort Worth, TX.

Instructor Training Highlights from April 2013

While Birth Boot Camp began with a mission to take childbirth education to more people through online classes, we have been honored to see incredible growth in our live classes.  Women with a passion for birth, from all around the country, have signed up for our instructor training workshops.  Now, just about a year into this business, we have instructors across the country and trainings beginning to span from coast to coast!

Let’s hear what these fabulous new instructors have to say about the comprehensive trainings that Birth Boot Camp organizes. 

  • “Awesome!”
  • “It (the workshop) has been invaluable in giving me the hands on prep I needed. I love having a village to help us.” Maggie

Included in the price of your training are all the materials you will need to get started as a childbirth educator.  Each new instructor receives an Instructor Manual, Instructor Handbook, Field Guide (student workbook), all of the Birth Boot Camp birth videos (you don’t have to find or buy your own) and supplemental videos for teaching specific subjects.

The only thing you will be required to buy when you start a class are workbook kits for your students.  Not only that, Birth Boot Camp has developed detailed lesson plans and game ideas that you can use when teaching your own class.

  • “The materials and all of the ideas given are so helpful and useful. I can’t wait to get started.”

One of the most important aspects of training is the opportunity that each instructor has to practice teaching to the entire group.  Everyone is assigned a topic and we meet together to listen and learn from each other.  Not only is this a wonderful time to practice and get used to teaching in a group setting, there are also some incredible ideas shared by these amazing instructors.

  • “I thought the teaching part would be scary but I ended up loving it during training. It was fun and so helpful!”
  • “I feel much more prepared to teach and more confident.” Beth
  • “I loved practice teaching!” Beth

And with that, we would like to introduce you to our newest crop of trained, natural birth instructors!  You can find all of our instructors, from coast to coast, on our Find a Live Class page.

 

 

How Birth Boot Camp Supports Midwives


 

One thing that is very important to us at Birth Boot Camp is supporting and encouraging the midwifery model of care. We are honored to have a very experienced and insightful midwife, Melody Morrow, CPM, as a member of our Advisory Board. Why is Melody so excited about Birth Boot Camp? She has seen the classes improve outcomes for her clients. Here are a few of her words. Thank you, Melody, for your support!

*****

Birth Boot Camp childbirth education has had an incredible impact on my midwifery practice.  As a midwife, I have found that the midwifery clientele has shifted recently and become more mainstream. Women are now choosing midwifery care that haven’t necessarily researched and taken responsibility for their choices in birth. Some just want to try a waterbirth because it looked cool on television. What this means for me as a midwife is that if I take these clients, I have to make sure they are properly educated before the birth.  If they don’t receive that education, I will likely be spending many, many more hours with them in pre-labor, labor and possibly a traumatic transport to the hospital.

I began to require that all my primips (first time moms) and women birthing outside the hospital for the first time take a childbirth class. While something was better than nothing, I didn’t necessarily notice a significant difference in outcomes for my clients who took a short class (4-6 weeks). However, I did notice that clients who took a longer Birth Boot Camp class did often have very different outcomes. Women were less fearful and more determined. They participated in their care and were making informed choices. Dads were providing excellent, confident support throughout pregnancy and, noticeably, in labor. Moms who would have otherwise had epidurals or C-sections, were having unmedicated births.

I believe Birth Boot Camp will enhance and support your work as a midwife because:

1. It promotes and affirms the midwifery model of care.  The Birth Boot Camp curriculum is based on the Mother Friendly Childbirth Initiative.  What they teach aligns perfectly with how I practice.

2. It gives parents 10 weeks of intentional education.  This enables parents to make appropriate decisions for their care and increases their ownership of responsibility. In short, more families “own” their birth choices.  Education lasts approximately 18-24 hours, so they simply have time to learn what they need.

3. The live classes promote peer support, encouragement and determination.  Think of these couples meeting for 10 solid weeks to learn about birth with like-minded people and a dedicated teacher who has done it before.  They are supported and positive about their birth and having more of their emotional needs met.

4. Someone else, besides you, is encouraging the same things you want them to hear.  Good nutrition, exercise, positioning, and much more are all things they are learning about OUTSIDE of your visits, not just during them.  My clients are more likely to be intentional in caring for themselves when they are given directed information, statistics, etc. and discussing these things with their partner and other birth workers.

5. Dads become more confident, involved and less fearful.  A confident and involved dad really helps with mom’s well-being.  Many clients will become even more passionate and appreciative of the choices they are making, even if they don’t have their desired outcome.

6. It is contemporary. The films are current and interesting.  The topics concerning birth and interventions are up-to-date.  In class, they discuss babywearing, cloth diapering, chiropractic care, doulas, Spinning Babies™, and other things that we want our clients to know about, but may not have time to fully teach them.  Their class will connect them to resources that I might not be able to.

7. It forces couples to stop and focus on their pregnancy in this fast paced world.  Couples connect with their pregnancy and with each other. They discuss issues and they come to an understanding. They appreciate their baby and the experience together.  I wish every couple did this!

 8. Knowledge is power. This means less confused, fearful phone calls and false labor runs for you.

In short, when my couples access the kind of quality childbirth education provided by Birth Boot Camp they have a better birth experience, my job is easier, and if things don’t go as they planned, they are comforted in knowing that they did all they could.  This kind of childbirth education truly makes a difference.

Melody Morrow, CPM, LM, BBCI loves babies and birth. Since 1998 she has attended over 1,100 births and assisted in the training of over 70 midwifery students. She is passionate about preventative, respectful care for mothers, babies, and their families. Melody works in Texas at Edenway Birth Center as the administrator and senior consulting midwife. She is enthusiastic about her calling and loves to help empower families as they become informed and educated about their choices during their maternity and birth experiences.

Oxytocin

 

What is Oxytocin?

Oxytocin is an amazing little hormone.

Even if you don’t know what oxytocin is, you probably notice its effects each day. Oxytocin is sometimes referred to as the “love hormone” and it has a unique role in many of life’s important events. Oxytocin is released by activities such as cuddling, nursing, massage, and lovemaking. Even hair brushing and chocolate can encourage oxytocin release. However, the largest release of this hormone is usually at the moment of birth.

The emotional and physical importance of Oxytocin-

The impact of oxytocin is twofold. First- it has an incredible emotional impact. As you probably guessed, it is often present when we do things that have a special ability to bind us to others. Oxytocin release during nipple stimulation (such as while nursing a baby) serves to bond us powerfully to our children. The incredible oxytocin “high” that is experienced at the time of birth causes a fierce attachment to our child and an overwhelming desire to love and protect them. The emotional impact of oxytocin is powerful in romantic relationships as well as the parent/child dynamic.

Second – it has an important physical component. The surge of oxytocin causes contraction of the uterus both during labor and after the birth. This is not only beneficial, but can actually be lifesaving, as it prevents excessive blood loss.

Oxytocin and your labor-

Imagine the typical charts of labor that you may have seen. Labor is often depicted as coming in waves or hills. Each contraction lasts for around a minute and is followed by a longer break. As time goes on, the contractions get longer and the breaks get shorter.

But what causes these rushes of contractions? What stimulates them? The answer is fairly simple- oxytocin. Produced in your brain, oxytocin is rhythmically pulsed throughout the body. This is, in part, why contractions come in waves with a break between them. (Note that a labor stimulated or sped by an IV drip of Pitocin may not follow this pattern. Pitocin is what artificial oxytocin, often delivered via an IV, is called.)

It is important to understand what can stimulate oxytocin during labor (relaxation, massage, nipple stimulation), because you can use this knowledge to speed or encourage good, strong labor, if necessary. The same things that make you open to oxytocin reception and production (feeling loved, safe, and secure) can help encourage healthy labor.

Think of the uterus at the time of birth. This large, powerful, and muscular organ has been stretched to capacity to hold a full term baby. Suddenly, as the baby delivers, it is empty and must quickly shrink down to a much smaller size. Let’s not forget that the uterus, during pregnancy, has a large organ (the placenta) attached to it on the inside. Shortly after the birth of the baby, the placenta detaches and delivers. The spot of placental attachment within the uterus leaves, what really is, a large wound. This place (the spot where the placenta was attached) is where we see blood loss from at the time of birth.

Now, if you have a large, stretched out organ with a large wound within it, how do we reduce the size of that wound and thus reduce subsequent blood loss? The answer is simple- we must quickly shrink the organ (the uterus) and thus the wound (the place where the placenta was attached). Oxytocin serves this special purpose. The contractions it causes (remember how strong they are at the time of birth?) help to quickly shrink the uterus and limit blood loss.

As a new mom often notices, the days after birth are not without contractions. Every time a new mom nurses her baby, these post-baby contractions (often called “after-pains”) may be felt. While they may be uncomfortable, after-pains serve an important purpose – they help the uterus continue to shrink down so that mom’s blood loss is minimized.

You can see that oxytocin is important to our day to day life but particularly vital during childbearing and the years after. Oxytocin emotionally helps us feel bonded and attached to our children. It also serves to protect the life of mom by helping minimize her blood loss postpartum.  There is a lot to love about the “love hormone.”

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