The Right Touch

Massage for Prenatal Health and Comfort By Phyllis Edgerly Ring

As you share your body with your developing child, you can also share the many benefits the comfort of prenatal massage brings to body, mind and spirit.

A woman's body goes through tremendous changes during pregnancy, when rapid weight gain causes a change in her center of gravity and her posture. Certified Massage Therapist Steve Traylor of Silver Spring, Md., says, "As her abdomen grows, the curve of her lower back increases and her knees rotate outwards. These changes put extra strain on the muscles of the hips and lower back."

Because of these changes, pain tends to develop in the muscles of the neck and back and in load-bearing joints in the hips, says Certified Massage Therapist Jennifer Berumen of Redwood City, Calif.

Big benefits from receiving prenatal massage from an experienced therapist include reduced edema (swelling) and pain associated with pregnancy. But many of massage's most powerful effects come with the relief it brings from anxiety, stress and depression caused by pregnancy's hormonal changes, Berumen says.

Benefits for Two
Reducing anxiety and stress also helps prevent complications associated with pregnancy. "Studies have shown that women with high levels of anxiety and stress have more complications, such as nausea and vomiting, longer labors, spontaneous abortions, postpartum complications, maternal illness and toxemia," says Melody Cook, a certified prenatal massage therapist and certified infant massage instructor in Dallas, Texas.

Elaine Stillerman, author of Mother Massage (Delta, 1999), has cited a recent study on the effects of maternal stress on the developing fetus. The findings indicate stressed pregnant women produce fetal heart rates that stay higher longer. This response has also been linked to retarded fetal development and higher risks of heart disease and diabetes later in life.

Studies also have credited prenatal massage with relief from fatigue, headaches, leg pain and cramps, constipation, nausea and indigestion. It also helps keep skin supple to help prevent stretch marks, strengthens muscles in preparation for labor and delivery, helps control blood pressure, relieves pain associated with pressure on the sciatic nerve in the buttocks and back of leg, allows for deeper breathing, enhances self-image, maintains posture and body balance and strengthens the immune system, says Berumen.

Prenatal massage benefits Mother and Baby by increasing blood and lymphatic circulation. By the 9th month, pregnancy can increase a woman's blood volume by as much as 50 percent, says Traylor. "Tense muscles constrict the blood vessels that pass through or between them, decreasing blood flow from an area of the body," he says. "Massage relaxes tense muscles so the blood can flow more freely. The lymphatic system works to remove excess fluid from the body, and increasing lymphatic circulation is what helps diminish swelling in the legs."

But Is It Really Safe?
It's important to check with your doctor for a list of contraindications that may apply to you and get a letter stating it is OK to receive massage, Berumen suggests. "Some therapists require this before they will even set an appointment," she says.

Common contraindications involve conditions of higher-risk pregnancies such as elevated blood pressure, heart disease, kidney and bladder disease, previous miscarriage, cancer, lupus, diabetes, mothers younger than 18 or older than 35, those with convulsive disorders or who are at risk for fetal genetic disorders, she says.

Prenatal massage should also be avoided during morning sickness, if the woman has a fever or is experiencing vaginal bleeding, if there is excessive swelling in the arms or legs, if it causes pain or where there are bruises or varicose veins, says Traylor.

"In most cases during the first trimester of a pregnancy, a mother should avoid massage therapy, as an increase in circulation can intensify morning sickness," Berumen says. If massage is performed during the first trimester, rocking movements should be avoided, as they may increase nausea, and abdominal massage should not be performed, says Cook.

After 24 weeks, pregnant women should not spend more than four minutes lying on their backs, so massage needs to be in a semi-reclining position propped up at a 45-degree angle, Cook recommends. During the third trimester, pain can occur in the pubic bone due to a separation of the pubic symphysis, and techniques that stress or pull on this joint should be avoided.

Cook prefers "properly supported side-lying positioning" as the safest way to offer prenatal massage. Some therapists, like Traylor, offer orthopedic cushions that have cutouts for the abdomen and breasts and transfer the woman's weight to her hip bones and collar bones to allow her to lie face down.

"As the baby grows, the mother has a harder time staying in one position for very long," says Traylor. For those in the later stages of pregnancy, he performs the massage in shorter segments: the top half of the front of the body, then the top half of the back, then the front of the legs and hips, then back of the hips and legs. In this way, the client is never in any one position for longer than 15 minutes.

Cook cautions that massage given with the mother lying prone must exercise great care not to stretch already-stressed lower-back and uterine ligaments or place pressure on the abdomen that might increase intrauterine pressure, a serious threat to pregnancies with abnormal placental attachment or function, uterine incompetence or decreased uterine blood supply.

Also, deep work should be totally avoided on the abdomen and limited to areas that are chronically affected by the pregnancy, Cook says, in order to avoid releasing too many toxins into the woman's system at one time. "This is especially important if the pregnant woman is or was a substance abuser or if she is likely to have more stored toxins because of her lifestyle, stress level or other considerations," she says.

"Toxins are trapped in tissues mostly because tense muscles constrict blood flow," says Traylor. "Like massage, exercise is a terrific way to increase blood flow and flush toxins from tissues. Massage increases the flushing of toxins in the same way and in about the same amounts as exercise does – and exercise is highly recommended during the entire pregnancy," he notes.

Deep pressure applied to pressure points on sides of ankles and in webbing between thumb and index fingers should always be avoided, as it can induce labor in some women. Most reflexology work should also be avoided during pregnancy, especially that applied to endocrine-gland points, so that the normal hormonal processes of pregnancy are not disturbed, advises Cook.

Find an Experienced Professional
Now that prenatal massage is especially "trendy," it's extra important to choose a qualified, certified prenatal massage therapist, says Cook. The best way is through a doctor's referral or through professional organizations such as the American Massage Therapy Association.

"A skilled massage therapist will welcome your questions," says Berumen. "Remember, this person can offer an incredible amount of assistance during your body's most transformational period."

"The pregnancy massage therapist is a part of the entire prenatal health care team," says Cook. "Especially at the beginning and middle of the pregnancy, the therapist may be seeing her client more often than the obstetrician or midwife does."

This makes a knowledgeable therapist an excellent source of information about safe and healthy pregnancy and childbirth, as well as a haven of comforting relief.

Want to see more?

• The Art of Prenatal Massage
• A Positive Adjustment: Is Chiropractic Care Right for You?
• Care of the Soul Spa Getaways
• Talk about it!

About the Author: Phyllis Edgerly Ring is a freelance writer.