Pregnancy Massage
Oh the joys of pregnancy! Spiritual connection with the unborn child; excited anticipation of the birth; the growth of a deep and more meaningful connection with your partner; joy and wonder at the strength and capability of the body. Any of you women out there recognize this picture? Or do you just remember your aching and swollen feet; bad back; shortness of breath; rib pain; overwhelming tiredness; nausea; and emotional mood swings? For most women, pregnancy is a mixed bag of physical, emotional and spiritual concerns which makes massage therapists with the right skills an indispensable part of any woman's prenatal care routine. Even women who have never been drawn to having a massage in their life will be delighted with the way bodywork can relieve the discomforts and pain of pregnancy, ease their stress and enhance their relationship with their body and unborn child. Clearly this is good news for massage therapists who are looking to increase their clientele, challenge themselves in a new area of bodywork and make deep and lasting connections with a unique (and very grateful!) client group.
The unique position of massage therapists
As bodywork therapists we are uniquely placed to help pregnant clients. Massage is a highly versatile therapy which helps not only to ease physical pain but can provide stress relief and a deep feeling of calm and well being. Those of you familiar with our articles in Today's Therapist, or our work at Jing , will know that we promote a multi-faceted approach to massage which emphasizes a dynamic creativity using a broad range of bodywork skills. This enables therapists to not only provide a massage which is unique to that client but can be an entirely different treatment to the same client at different times, depending on their needs and the outcomes required at that session. This not only promotes a high level of customer satisfaction and return rate; it prevents you, the therapist, from becoming bored and disconnected with your work. The same is true with pregnancy massage; there is no such thing as one pregnancy massage or routine; the skilled therapist will have a 'toolbox' of skills and techniques coupled with a knowledge and understanding of pregnancy related complaints and contraindications. This means that any pregnancy massage can range from trigger point therapy to ease aches and pains, to Thai style stretches to increase flexibility, to cranio-sacral techniques to achieve deep relaxation. And yes all of these can happen in the same session - this is the art and science of true bodywork!
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The benefits of pregnancy massage
- Stress Reduction and Relaxation: Pregnancy is often a time of intense emotion and change. To say it is challenging is an understatement. It is understandable that it can become an emotionally stressful as well as overwhelmingly challenging time of a woman's life. Research shows that stress has many adverse effects pre and post natally including higher incidence of miscarriage, prolonged labours with more complications; increased perinatal foetal distress, low birth weight and infant irritability. Unsurprisingly, learning how to relax is an integral part of most childbirth education programmes and pre-natal classes. The lasting benefits of massage in stress reduction are well documented; experts recommend that women practice deep sustained levels of relaxation for 45-60 minutes per day, especially in the last 6-8 weeks of pregnancy- the exact length of most massage sessions.
- Circulatory Benefits: To provide for the needs of the unborn child, the mother's circulatory system has to undergo some profound changes. These can result in discomforts such as oedema, varicose veins and high blood pressure, all of which often respond well to appropriate massage therapy. Myofascial restrictions in the inguinal (groin) area contributing to leg oedema and varicose veins can be treated with passive movement techniques and gentle work with hip joints. Hydrotherapy- appropriately using hot and cold, in your treatments can ease swelling and pressure on the system. The manual movements of effleurage, petrissage and kneading means that lymph capillaries are repeatedly emptied and refilled producing a sustained increase in the rate of lymph formation and removal.
- Respiratory Benefits: Most expectant mothers tend to feel short of breath due to the growing uterus restricting the diaphragm and the anterior rotation (rolling inwards) of the pectoral girdle (shoulders and chest) due to increased breast size. Appropriate trigger point therapy and stretching of primary and secondary muscles of respiration such as SCM, intercostals, scalenes, pectoralis major and minor can assist in more efficient breathing and relieve musculo-skeletal pain on neck, chest and upper back.
Pain relief and reduction of musculo-skeletal strain: Musculo-skeletal pain and strain is an almost inevitable consequence of pregnancy and massage therapists with the appropriate skills can help to relieve or in some cases alleviate this entirely. Pregnancy leads to a number of structural stresses including:
- Anterior rotation of the pelvis increasing the lumbar curvature. To compensate, a woman's upper ribcage leans more posterior and her head and neck juts forward. These compensations all lead to strain concentrating in the posterior musculature causing back, neck and shoulder pain.
• Collapsing weight onto the medial arch of feet, forward rotation of pectoral girdle, compression of all weight bearing joints and myofascial structures due to increased weight gain.
• Softened connective tissue, ligaments and tendons due to the effect of the hormone relaxin which prepares the body for labour. This can also contribute to joint instability and strain on weight bearing structures especially in the lumbar spine and pelvis.
Specific common pain problems in pregnancy
- Back pain : This is extremely common in pregnancy and up to 56% of women report their first incidence of chronic back pain during pregnancy especially during the last trimester. Pain in one or both buttocks that radiates down the posterior leg can also be due to compression of the sciatic nerve by chronic piriformis tension. This can be effectively treated with appropriate massage techniques including trigger point therapy, myofascial release and stretching.
- Nerve impingement syndromes: Other common musculo skeletal pains in pregnancy include nerve impingement syndromes, of which carpal tunnel syndrome is the most common. This is characterised by numbness and pain in the hands, arm and wrist and can be caused by compression of the medial nerve due to oedema. It is important to realise that this type of pain can also be due to compression of the brachial plexus at the thoracic outlet due to change in posture from pregnancy and can often be effectively treated with trigger point therapy, massage and stretching (for more information on carpal tunnel related syndromes refer to our previous article in Todays Therapist). A similar condition known as tarsal tunnel syndrome can cause numbness in the foot and ankle due to compression of the tibial nerve by oedema.
- Cramping: This is common in the gastrocnemius/soleus group and can be relieved through massage and stretching.
- Ribcage pain: This is another common condition as organ space decreases in later pregnancy. Appropriate massage and myofascial work can help to relieve the structural stresses on the ribs and alleviate pain.
Safe and appropriate massage therapy during pregnancy
Although massage is a safe and appropriate therapy during pregnancy it is important that you are aware of special considerations and pregnancy related contra-indications before treatment. Some of the most important factors involve client positioning; most of us are taught to massage in prone and supine positions only, yet both of these positions are problematic for the pregnant client.
The prone position is particularly problematic for pregnant women due to the following concerns:
- Exerts strain on lumbar, pelvic and uterine structures. The prone position aggravates the cause of many women's back discomfort, particularly in later pregnancy.
- Causes increased intrauterine pressure when pressure is applied. This should be avoided with all pregnant clients
- Can cause increased pressure on breasts
- Can cause unacceptable congestion due to increased mucous production and inability to use anti histamines or other sinus mediations.
There are many products on the market that attempt to accommodate the pregnant belly i.e. on site massage chairs, tables with cut out ovals. However these alternatives do not solve the problem and either further strain the uterine ligaments by dangling the uterus from these attachments or cause increased intrauterine pressure particularly when pressure is added during the massage.
Supine positioning also involves safety considerations. In the supine position the uterus rests against the inferior vena cava (IVC). Extended compression of the vena cava will result in low maternal blood pressure and decreased circulation to both the mother and baby. Therefore even with expensive and well designed equipment, these positions are not recommended.
The Supremacy of Side lying Positioning!
The side lying position is generally considered the safest and most comfortable for most pregnant women. With the right training you will be able to comfortably treat the whole body from this position and learn techniques that will not only enable you to do a great pregnancy massage but give an added dimension to all your treatments. The side lying position is excellent for treating other clients who are unable to lie supine or prone and also enables you to effectively treat the shoulder girdle and muscles such as the gluteus medius and iliotibial band that may be more difficult to access in other positions.
Your Supreme Position
Knowing creative ways to massage and treat pregnant woman can change more than one life: your client's, her partner's, her support network, the unborn child and definitely yours. Your professional satisfaction will grow with this knowledge and so will your practice. It is an amazing thing to share such a gift with so many.
About Jing. www.jingmassage.com
Jing Advanced Massage + Training is an organisation dedicated to excellence in all aspects of postgraduate massage training. Offering a unique range of Holistic Medical Massage workshops for treatment of pain, including low back and neck and shoulder, we also offer courses in Hot StoneFusion, Advanced Stretching and Pregnancy Massage. Based in Brighton , we offer courses around the country
Tel: 01273.628.942.
Email: info@jingmassage.com
Text Copyright Rachel Fairweather and Meghan Mari 2005
Photos by Meghan Mari