by Leslie Stager
My friend has a busy sports massage practice. She works with pregnant and non-pregnant clients often doing deep tissue work in hip adductors, hamstrings, calves, and quadriceps. One day we were discussing pregnancy massage adaptations — sidelying and semi-reclining positions, altered body mechanics, and relevant bodywork precautions.
“What precautions?” she asked.
I mentioned the 5x increased risk of developing blood clots during pregnancy, and greater risk for six weeks after birth. I stated that massage therapists should do thorough intakes and adjust their bodywork for those with specific risk factors, such as recent airplane travel, obesity, a history of previous clots, carrying twins or more, being over 35 years old, or recent cesarean section. Seventy-five percent of pregnant and postnatal women who develop clots have one or more of these risk factors.
“If your client has any of those conditions, do you know you really should not do deep sports massage to the inner thigh and calves where most clots develop? Since they are often not symptomatic, you wouldn’t know if they had one!” I stated.
“What else?” she asked.
“Progesterone increases cause vasodilation, so her blood pressure often will drop when she sits up after lying down. She may get really dizzy, so be sure she waits for a moment before getting off the table!”
“That happened to a client today!” she murmured.
“How she sits up is also important. If she jackknifes up, like many do, the abdominal muscles strain. Many pregnant women have separations of the rectus and the pubic bones, partly because of this. She must use her arms to push up, not pull with her belly!”
“Is that what causes the uterine round ligament pain in the groin too?” she asked.
“Absolutely!”
We talked more. She used sidelying positioning, but without extra pillows supporting the upper leg and pregnant belly. Sidelying offers excellent access to neck, quadratus lumborum, hips, and the IT band, and we both love it for all our clients, not just pregnant ones. But without proper support, you might actually increase some of the very discomforts women are coming to see you about! Support under the belly prevents uterine torque and ligament strain; leg pillows align the hip and knee, keeping lateral hip rotators relaxed.
Twice my friend had full-term pregnant clients whose bag of water broke during a session. “Could I have caused that?” she wondered.
Unless she was doing unusual and extreme abdominal massage or had clients positioned improperly for extended periods with other risk factors present, she would not cause the water to break, I assured her. But her concern was understandable!
Most students learn a little about pregnancy massage in school. Unfortunately many myths are still perpetuated, while real concerns are often not addressed. I remember another friend whose first trimester pregnant client miscarried one day after her massage. She believed for decades she had caused the miscarriage and actually quit her massage practice because of it, even though we know miscarriage in the first trimester is extremely common and nurturing massage does not cause it!
There’s no reason not to expand one’s knowledge and repertoire to include the needs of pregnant clients. All manual therapists should know fundamental principles of positioning and red flag symptoms of danger. You never know who will come through the door! Yesterday, I had a client who could not lie on her side due to heartburn; we repositioned to semi-reclining and continued the massage.
Several times I’ve had clients arrive with early red flag symptoms. I had them call their midwife before continuing the session with me. Another client told me she was positioned flat on her back for a 40-minute acupuncture session. She started to get uneasy, and asked to reposition. Gravity can cause the weight of baby, placenta, and amniotic fluid to compress the mother’s inferior vena cava and aorta, reducing her own and baby’s blood flow. It can cause dizziness, nausea, and a decrease in the baby’s heart rate. Supine position should only be used for brief periods, and only with regular communication about the client’s comfort.
In many instances minor adjustments will drastically improve the safety and comfort of a pregnant client, but if you don’t know options, you may never think to offer. Recently a prospective student called saying she turned away a pregnant client because she was nervous to massage her. Her employer nearly fired her because of that. If you expand your skills and confidence to accommodate the special needs of pregnant clients, you won’t lose your regular clients when they get pregnant! They have a few special requirements, and offer you an opportunity to expand your repertoire in sidelying position, which expands your options for all your clients!
LESLIE STAGER RN, LMT, has been a leading Prenatal, Birth, and New Mother Massage specialist for over 20 years. She is author of Nurturing Massage for Pregnancy, producer of the MotherTouch dvds, and instructor on the dvd Mastering Pregnancy Massage. She will return to FSM this January to offer Fundamentals of Pregnancy Massage, MotherTouch Prenatal Bodywork Certification, and Advanced Techniques for Women’s Health.
Register at: www.TouchForBirth.com or Leslie@TouchForBirth.com or call (207) 323-5101.
