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.
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.