Perinatal Massage

As Carole Osborne-Sheets states in her book Pre- and Perinatal Massage Therapy,

As Carole Osborne-Sheets states in her book Pre- and Perinatal Massage Therapy, “Appropriate touch with childbearing women has the potential to positively change not only individual women and their families, but also to knit an ever-widening fabric of nurturing touch to help unite and transform our current violent, touch-aversive societies.”

Sidelying during a massage is safe and most recommended for the pregnant patient.   Advertisement

I often speak of the importance of massage for babies, but shouldn’t we also promote this nurturing touch for the pregnant mother? She can nurture her growing baby and body from Day 1 of conception and learn appropriate self-care, have massages, and build a relationship with a health-care provider with whom she can communicate openly about her pregnancy.  Chiropractic can offer many benefits to the pregnant mother and can be accompanied by massage therapy to optimize the mother’s health and pregnancy experience.

As massage therapists, we bear witness to many life-changing events in our patients’ lives. Pregnancy is a time of transition – a woman’s body is growing and changing to prepare her for birth and becoming a mother. It is a time of strength and vulnerability.

RMTs working with pregnant women have the opportunity to explore their pregnancy with an intimacy that she often does not share with another person, other than her partner. Not only can we help her relax and treat her body pains, but we can form a close bond. We have an awareness that it is important that we create a caring, non-judgmental clinical environment for women to openly and honestly express the many emotions they experience during pregnancy.

I recently read a study from the Miami School of Medicine in the Touch Research Institute, where researchers found that after receiving pregnancy massage, “only the massage therapy group . . . reported reduced anxiety, improved mood, better sleep and less back pain by the last day of the study. In addition, urinary stress hormone levels (norepinephrine) decreased for the massage therapy group and the women had fewer complications during labor and their infants had fewer postnatal complications (e.g., less prematurity).” (Field et al., 1999)

FERTILITY AND MASSAGE
The childbearing years for women can be exciting and stressful at the same time. For some, getting pregnant is easy. For others, the cost and stress of fertility procedures can make getting pregnant emotionally, financially and physically draining. A massage therapist can help a pregnant woman decrease stress, help nurture her body as it undergoes medical treatments, and help her to reconnect with her body. I usually ask my patients how they got pregnant so that I can get a clearer picture of what they have been going through physically and emotionally for the last year or so.
   
POSITIONING FOR A SAFE AND COMFORTABLE TREATMENT
It is not up to the pregnant patient to know what positions are safe for massage. As her RMT, we can educate her on safe positions and make sure she is comfortable on our table. Often, new patients ask about the massage tables with a hole for her belly or pregnancy pillows that allow her to lie prone in her second and third trimester. It is not OK for your patient in her second or third trimester to be prone for any reason. The prone position on a table with a hole puts too much strain on the sacrouterine ligaments and the prone pillows increase intrauterine pressure. These positions actually make some patients feel more stressed out.

I splurged on an ergonomic pillowing system. It is well worth the money and I get asked by patients where they can buy the pillows for sleeping at home all the time. Patients who have experienced the latter tell me that now, lying on their side, they realize how they were so tense on those tables, or lying prone, how they couldn’t fully relax. The supine position can be done by placing pillows behind her back, to create an incline, and under her knees, while supporting her right hip with a wedge pillow to avoid supine hypotensive syndrome. Sidelying is most recommended to patients by their midwife or obstetrician because it is safe, facilitates sharing, avoids sinus congestion, decreases edema, maximizes maternal cardiac function and fetal oxygenation and avoids intrauterine pressure.

THE RMT AS A TRUSTED RESOURCE
Appointment booking times are a lot longer for massage therapy treatments than for any of a woman’s other health-care treatments. An RMT can become a practitioner she sees often, and with her appointments lasting from 30 to 90 minutes, the relationship we create allows the patient to feel safe receiving massage during such an important time in her life.

The RMT’s pressure for belly massage during pregnancy is very light and is not meant to palpate the baby as her midwife or obstetrician does.

The Internet is a powerful tool, full of ideas and comments about pregnancy and childbirth. But what most people don’t realize is that a lot of Internet content is laregly made up of opinions. The pregnant woman of 2013 is bombarded with advice from the Internet, family, friends and even strangers. Although no one means any harm, most women like to share their birth story and experiences with a mom-to-be (which can be scary for your patient to hear), but it is important that the patient has a trusted source of information, to ask questions of and use as a sounding board for ideas. An RMT can be that source.

I recommend to RMTs that that they get to know other health practitioners in the area who have a focus on pregnancy and perinatal care – examples are physiotherapists, chiropractors, osteopaths and breast-feeding specialists – as well as community support such as a post-partum depression line or local mom groups.
   
BELLY MASSAGE
One of my favourite aspects of working with a pregnant patient is soothing and calming her unborn baby through abdominal massage. This requires for us to obtain special consent before this type of treatment and to explain the benefits of abdominal massage to the patient, namely, that it encourages relaxation; promotes circulation to her uterus; helps her bond more with her baby; and serves as, essentially, her baby’s first massage. Our pressure is light, and is always lighter than an ultrasound technician, and is not meant to palpate the baby as her midwife or obstetrician does. Techniques can include clockwise circles, sun/moon technique, criss-crossing and multi-directional effleurage strokes.

TAKE SOME PRECAUTIONS WITH MASSAGE
Here are some elements that RMTs  keep in mind when massaging a pregnant patient:       

• Relaxin hormone, produced by the ovaries and placenta, relaxes the ligaments in the pelvis and softens and widens the cervix.
• Separation of pubic symphysis, means we try not to move patient too much.
• Avoid reflexive techniques to the lower leg and feet – consult a reflexology chart for specific points.
• Adjust treatments for hyper/hypotension, diabetes or any other high-risk concerns.
• Nausea is usually experienced in the first trimester but can be experienced throughout pregnancy – clients suffering from nausea will not appreciate rocking or rhythmical movements.

LABOUR SUPPORT
Being a massage therapist and also doubling as a labour support provider is becoming a popular trend for therapists who treat a lot of pregnant women. It is a unique relationship: because therapist and patient already have a connection, it allows the patient to be herself during birth and trust in our guidance as her labour support.

POSTPARTUM
Massage is safe within the first few hours or weeks after birth. Unless she has a doctor’s referral that states otherwise, a  C-section mother will always be positioned sidelying for at least four weeks or until her incision is less sensitive.

Working with women during such a transitional time in their lives, is so rewarding and RMTs can take a special role in this experience. 

“To nurture the birth of a mother and of her baby with skilled touch is one of the most intellectually challenging, emotionally and physically demanding, humbling, inspiring and life-enhancing experiences that a somatic practitioner can engage in.”

SOURCES USED FOR THIS ARTICLE

• Field T, Hernandez-Reif M, Hart S, Theakston H, Schanberg S, Kuhn C. Pregnant women benefit from massage therapy. J Psychosom Obstet Gynaecol. 1999 Mar;20(1):31-8.
• Osborne-Sheets, C. Pre- and Perinatal Massage Therapy: A Comprehensive Guide to Prenatal, Labor, and Postpartum Practice. Copyright 1998, Body Therapy Associates. San Diego, CA 92128.
• Bastard J, Tiran D. Aromatherapy and massage for antenatal anxiety: its effect on the fetus. 2006 Feb;12(1):48-54. E-pub 2005 Oct. 6, accessed March 8, 2013.

Nicole Nifo has been practising as a Registered Massage Therapist since 2005. She has extensive massage therapy training in obstetric and pediatric patients. For six years, Nicole has been managing a family-focused practice through her clinic, Fully Alive Wellness Centre in Oakville, Ontario. She has also written many MT-related articles for women and children and continues to strive to find new ways of communicating the importance of nurturing touch for children. Nicole can be reached at www.fullyalivecentre.com or on twitter @FullyAliveWC.