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Pregnancy Massage

Pregnancy-Massage-bigBenefits of Massage During Pregnancy

  • Relieves muscle spasms, cramps associated with the stress of extra weight bearing and physical changes that occur during pregnancy.
  • Reduces stress and teaches the mother to  relax.
  • Relaxation is one of the keys to labor and delivery.
  • Gestation processed enhanced through increasing blood circulation, lymph circulation, reducing edema, increasing cellular respiration.
  • Provides emotional support and physical nurturing; this may be passed on to the baby.
  • Assists in reducing the stress in the weight bearing joints and musculoskeletal structures.
  • Helps maximize breathing capacity which is needed during labor and delivery.

Pregnancy Contraindications

High Risk Pregnancies Do not proceed without written release of physician.

  • Diabetic Mother
  • Cardiac Disorders- heart disease
  • Chronic Hypertension
  • Previous Problem in Pregnancy – previous miscarriage
  • Mothers under 20 or over 35
  • Asthmatic Mother
  • Suspected RH Negative Mother or other genetic problems
  • Drug addictions or exposure to drugs
  • Previous multiple births

Proceed With Caution (Physician’s Release Advised)

  • Incompetent cervix
  • Complications due to DES used during pregnancy
  • Lung or live disorder
  • Severe anemia
  • Convulsive disorders
  • Abnormal Fetal Heartbeat
  • Decrease or absence of fetal movement
  • Interuterine growth retardation
  • Lupus Erythematosus
  • Poor lifestyle habits (drug abuse, poor nutrition, smoking, alcohol consumption)
  • Low weight gain
  • No prenatal care

Warning Signs of High Risk Factors

  • Possible Miscarriage – bloody discharge, continual abdominal pains, sudden gush of water or leakage of amniotic fluid
  • Urinary Tract Infections – very frequent urination with burning, low back pain increase in thirst and decrease in urination, chills and fever with 100 degree temperature or higher
  • Pre-eclampsia – (toxemia of pregnancy – if neglected or not treated properly may develop true eclampsia)  Sudden rapid weight gain, systemic edema, increased blood pressure (hypertension), protein in urine, increased headaches
  • Eclampsia (Toxemia) Emergency situation-refer to physician immediately- Develops in 1 out of 200 patients with pre-eclampsia; persistent severe headaches; persistent severe back pain unrelieved by change of position; severe nausea/vomiting; systemic edema; pitted edema, increased blood pressure; visual disturbances; convulsions.
  • Gestational Diabetes – excessive hunger and thirst; increased urination in 2nd trimester; sugar in urine, no non-pregnant diabetes
  • Other conditions – thrombophlebitis; systemic infections; skin irritations; varicose veins; kidney disease; heart disease; cancer; acute injuries such as burns, bleeding, fractures

Contraindications for Massage

  • Abdominal massage totally contraindicated for 1st trimester and limited to effleurage for remainder
  • Gymnastics/ ROM – do not do movements when nausea present; or when symphysis pubis separates ( 2nd trimester)
  • Pressure point around ankles and Achilles tendon should be avoided; pressure point between thumb and finger should be avoided
  • Swedish stokes that affect circulation should not be used in the 3rd trimester if the client has a heart condition
  • Tapotement contraindicated on the legs because of the increased danger of blood clots during pregnancy

Be conservative and consult the physician with any questions.  Obtain release to work on client.

Physiological Changes of Pregnancy and Bodywork Suggestions

Area of change  Changes suggestions for massage/bodywork
Abdominal wall
  • fascia, muscle, skin stretches
  • stretch marks may appear
  • rectus abdominus under considerable strain
  • linea alba may give way  ( diastasis recti)
  • abdominal contents protrude at midline
  • cross-fiber attachments of obliques along rib cage to relieve tension
  • avoid direct abdominal work
Breasts
  • enlarged and sensitive by the 8th week
  • increased vascular supply
  • 5th month preparation for lactation
  • stretch marks
  • chloasma around nipples and areola
N/A
Skin
  • drier or oilier
  • acne
  • stretch marks
  • linea nigra -brownish streak down mid-line of abdomen
  • chloasma (mask of pregnancy) around eyes and in labia majora/minora
  • apply cocoa butter
  • apply the following mixture:      1/2 c virgin olive oil, 1/4 c aloe vera gel, 6 capsules vitamin E oil cut open, 4 capsules vitamin A cut open. Mix and store in refrigeration. Apply daily.
Pelvic floor
  • stretches in preparation for labor
  • stretches due to extra weight of baby
  • Stretch adductor muscles
  • kegel exercises for strengthening
Circulatory system
  • heart size increases and moves anteriorly (upward and to the left)
  • expansion of vascular channels
  • blood volume increases 30-50%
  • increase in red and white blood cells
  • interstitial fluid volume increases 40% in 3rd trimester causing edema in legs
  • femoral venous ( sapphenous, iliac, femoral, parametrial) pressure increases due to pressure of enlarging fetus on pelvic veins causes varicose veins and edema
  • Women with underlying heart disease at greatest risk for heart failure in 3rd trimester.
  • Use caution when working on legs as an increase in blood clots can occur.
  • Adductor muscles need to relax to relax the pelvic floor
  • Use side lying position
Respiratory
  • increased breathing rate-possibly hyperventilation
  • lower rib cage flares out and diaphragm elevates to make room for the baby
  • accessory muscles used for breathing (scalenes, external intercostals, pec minor)
  • Teach breathing
  • release scalenes, intercostals, pec minor
  • release all rib cage areas
Gastrointestinal and Urinary
  • saliva becomes more acidic increasing tooth decay
  • excessive gum bleeding
  • gastric acidity and vomiting in 1st trimester
  • peristaltic activity and muscle tone of colon decreased causing constipation
  • increased pressure on sigmoid colon causes constipation
  • 20th week: stomach pushed upward into left dome of diaphragm may cause hiatal hernia
  • gall bladder emptying increases
  • urinary infections common
  • bladder capacity decreases as uterus enlarges
  • Work with reflexology to stimulate digestion
  • Have mother urinate before session whether she needs to or not.  Be prepared for her to get up and go during session.
Musculoskelatal
  • 10 weeks -hormone relaxing produced relaxing the ligaments in SI joint and symphysis pubis; also affects other ligaments
  • general decrease in myofascial pain
  • weight bearing joints placed under more stress due to weight gain and postural changes
  • weight gain in front of body causes woman to lean back changing the center of gravity allowing the pelvis to rotate forward, placing more stress on the SI joint, lumbar spine and stretches abdominals
  • other muscles stressed; pectoral, abdominals, QL, pelvic floor, erector spinae, iliopsoas
  • Increase their awareness of the connection between breath and relaxation
  • Work psoas of women before pregnancy
  • check position of tailbone
Endocrine
  • increase in size and output of pituitary, thyroid, parathyroid, adrenal glands
  • estrogen targets thighs, buttocks, hips to store extra fat
  • estrogen increases size of uterus, cervix, genitals, breasts
  • estrogen decreases stomach acid which can lead to heart burn and indigestion
  • progesterone relaxes smooth muscle and dilates peripheral blood vessels, leading to decrease in peristaltic activity, urinary bladder dysfunction, hemorrhoids, varicose veins and edema.
  • do not do any reflexive work that stimulates endocrine  points

Trimester Information for Massage Practitioners

Pregnancy-trimester

First: 14 weeks from the 1st day of last period

Baby:  from egg to 3″ long, fully developed body, arms, legs, nails, ears

Mother:  uterus grows; heartbeat heard at day 26; increase in nausea and vomiting possible; at 10 weeks relaxin begins affecting joints – minimal structural changes occur; fatigue; increased blood volume and increased heart rate; metabolic changes; increase in frequency of urination; constipation; anemia; headaches and dizziness possibly due to hormonal changes.

Massage:  Risk of miscarriage the highest; no abdominal massage; do massage to assist circulation; no reflex massage; no passive ROM if nauseated

Treatment plan: focus on postural alignment; pelvic, diaphragm, rib cage, low back.
teach relaxation techniques and deep breathing exercises, kegel exercises, pelvic clock exercises

Second: 14-28 weeks

Baby: grows to 11″ and 1 1/2 lbs. fingerprints, eyebrows and eyelashes form; 16 weeks sensitive to light; 24 weeks hearing develops; 29 weeks opens eyes and looks to light source.

Mother: Structural changes: stress on low back upper back, pectorals; rib cage flares out at base and elevates; diaphragm elevates at rib attachments; breathing is mostly costal; abdominal breathing difficult; linea alba separates;  center of gravity changes to adapt to extra weight held in front.
Varicose veins and muscle cramping occur.  Skin stretches. Breasts swollen and tender.

Massage: Decreased risk of miscarriage; deep tissue ok on areas of chronic stress; joints less stable due to relaxin especially SI joint, symphysis pubis and hips.

Treatment plan: Focus on increasing breathing capacity, releasing abdominal attachments at lower rib cage; releasing intercostals. Watch for sciatica, low back and upper back  problems related with changes in center of gravity.  Continue to teach relaxation and connection to breathing.  Open up pelvic floor by working on adductors, hamstrings and rotators later in this stage

Third: 28-40 weeks

Baby: 14-16 ” and 2 1/2 -3 lbs: at start; grows to 5-9 lbs. and 20″ in length; 29 weeks lungs developed; 32 weeks brain development, eyes track movement, sleep patterns develop.

Mother: Shortness of breath, difficulty breathing as uterus grows to rib cage; diaphragm rises 1 1/2 ” upward; Difficult to move and walk; hemorrhoids, varicose veins, heartburn, hiatal hernias, frequent urination, constipation, trouble sleeping, edema in ankles and legs, carpal tunnel, stress to heart

Massage:  same as in 2nd trimester

Treatment plan: Decrease stress to postural muscles – adductors, legs, hips, low back.  Decrease edema. Increase relaxation.

Pregnancy Massage Articles Online

  • Massagenerd.com – Pregnancy Massage Section
  • The Evolution of an MT From Office to Birthing Room By Caitlin Philips : Massage and Bodywork Magazine
  • Miracle of Motherhood By Erik Dalton : Massage and Bodywork Magazine
  • Pregnancy Massage Touch for the Mom-To-Be By Shirley Vanderbilt  Massage and Bodywork Magazine
  • High-Risk Pregnancy By Kate Jordan, NCTMB Massage Today
  • Pregnancy Leg Massage By Elaine Stillerman, LMT Massage Today
  • Maintaining Core Integrity During Pregnancy and Postpartum Recovery By Elaine Stillerman, LMT  Massage Today
  • Pelvic Pain in Pregnancy By Kate Jordan, NCTMB  Massage Today
  • Prenatal Massage During the First Trimester By Elaine Stillerman, LMT
  • The Truth About Pitocin By Elaine Stillerman, LMT
  • To C or not to C? That Is the Question By Elaine Stillerman, LMT
  • Maintaining Core Integrity During Pregnancy and Postpartum Recovery By Elaine Stillerman, LMT
  • Keeping Cool Through Pregnancy By Elaine Stillerman, LMT
  • Help Your Client Achieve a Natural Labor: Four Simple Tips for Pain Relief By Michelle C. Larson, MAc, BA, LMT
  • Touching the Unborn How Energy Therapy Can Be Applied In Utero By Karrie Osborn Massage and Bodywork
  • Holistic Maternity Care Integrating Shiatsu and Massage By Suzanne Yates
  • Prenatal Massage During the First Trimester By Elaine Stillerman, LMT
  • Laboring Naturally Lifespan By Karrie Osborn Massage and Bodywork Magazine

Pregnancy Massage Training/Classes/ Books

  • www.massagedoula.com
  • www.MotherMassage.net
  • www.bodytherapyassociates.com – Comprehensive educational opportunities with Carole Osborne-Sheets
  • Kate Jordan Seminars – Bodywork for the Childbearing Years
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