Part 1 of 6. There are myths with pregnancy and massage, including not massaging a woman in her first trimester and avoiding her ankles. The American Pregnancy Association (1) states “Women can begin massage therapy at any point in their pregnancy – during the first, second, or third trimester.” No matter what trimester, massage therapists should always be checking in with clients before massage, looking for new contraindications & the general well being of the client. Over a series of six posts, we will look over massage during each trimester, as well as conditions related to pregnancy, contraindications, & how to modify technique or client position.
Pregnancy massage is modification of techniques & body positions to meet the needs of women as they undergo changes during pregnancy and the postpartum period.
Pregnancy is a sequence of events that begins with implantation, continues with embryonic and fetal growth, & ends in childbirth. Normal gestation is approximately 10 lunar months; (40 weeks, 9 calendar months, or 266 days) & is divided into trimesters.
The first trimester is the first 14 weeks of pregnancy (from the first day of the last period). The placenta develops with the fetus. The mother and fetus exchange nutrients and wastes and serves as a filter system that allows small molecules such as glucose, oxygen, and nitrogen to pass. Unfortunately, many drugs, alcohol, viruses (e.g., rubella, HIV), and other toxic substances can also pass through the placenta, producing negative effects on the unborn child.
The second trimester spans week 15 to week 28. The mother begins to “show,” & she should feel the baby move in the middle second trimester (called quickening). The fetus grows to approximately 11 inches in length and weighs about 1.5 lb.
The third trimester is week 29 to birth, which is around week 40. The fetus grows to about 20 inches in length and between 5 and 9 lb. in weight. The mother may experience occasional, preparatory contractions in which the uterus hardens and then returns to normal. Colostrum, the early form of breast milk, may leak from the breasts. As the fetus grows and the uterus enlarges, many internal structures become displaced.
Labor usually begins after the fetus reaches a gestational age of approximately 40 weeks.
MASSAGE THERAPY DURING FIRST TRIMESTER OF PREGNANCY – The first trimester is the first 14 weeks of pregnancy. Modifications are made for miscarriage signs and symptoms, deep vein thrombosis, morning sickness, and breast changes.
Miscarriage –Miscarriage is the premature termination of a pregnancy and occurs in approximately 20% to 30% of all pregnancies. In most cases, the cause of miscarriage is unknown. Signs and symptoms of miscarriage are abdominopelvic pain, cramping, or vaginal bleeding or spotting. Miscarriage is also called spontaneous abortion.
Massage Therapy & Miscarriage – Postpone massage therapy if she is experiencing any signs or symptoms of miscarriage and refer your client to her obstetrician or health care provider who is managing the pregnancy. This restriction is true for all trimesters. The time after miscarriage can take be emotionally as well as physically taxing. Be sure your touch and presence are supportive and compassionate during the grieving process.
Deep Vein Thrombosis –Deep vein thrombosis, or DVT, is inflammation of a deep vein with blood clot formation. The most serious complication of DVT is pulmonary embolism as 90% of pulmonary emboli originate as blood clots from leg veins. Because of decreased clot-dissolving properties during pregnancy and increased clot-producing factors, pregnant women are at a higher risk for DVT; five to six times greater.
Massage Therapy & DVT – Screen all pregnant clients for DVT by looking for signs and symptoms. Signs and symptoms of DVT are unilateral leg swelling, heat, redness, pain, and tenderness. If your client has any of these signs or symptoms, postpone the massage and refer the client to her obstetrician or appropriate health care provider for evaluation and treatment. This restriction is true for all trimesters and continues until week 10 postpartum.
Morning Sickness – Morning sickness or the nausea and vomiting of pregnancy (NVP) affects approximately 75% of pregnant women during the first trimester. NVP can begin as early as day 10 and usually dissipates by week 14. Some women feel nauseated throughout pregnancy.
Massage Therapy & Morning Sickness – Consider using a semireclining or upright position during most of the session because this position may reduce nausea. Massage promoted relaxation and reduced the negative impact of severe NVP (2). Acupressure reduced NVP symptoms (3) as did acupressure applied to P6 using human hands (4) or a wristband (5, 6) used to apply constant pressure (see picture for what the wristbands look like). P6, or Pericardium 6, is an acupoint located three finger widths above the wrists on the anterior surface of the forearm. Avoid techniques that cause the client to rock or shake as excessive body motion may worsen nausea.
Breast Changes – Female breasts undergo many changes during pregnancy. Blood supply to breasts increase and they become enlarged and tender, usually by week 8. Breasts may leak colostrum (early breast milk) in preparation for their job of infant nourishment, but this is more common in the third trimester.
Massage Therapy & Breast Changes – Use supportive cushions and positional modifications to make her as comfortable as possible. If she elects to wear a bra during the massage, modify your technique to work around the bra or ask if you can unhook the bra to work the mid-back area. Be sure to memorize the hook position and rehook the bra when the massage to the mid-back is complete.
** The next blog will discuss pregnancy massage and side lying positions. **
Stillerman E: Prenatal massage: a textbook of pregnancy, labor, and postpartum bodywork, St Louis, 2008, Mosby.
Articles and Journals Referenced:
- Agren, A., Berg. M., (2006). Tactile massage and severe nausea and vomiting during pregnancy—women’s experiences. Scand J Caring Sci. 20(2). 169-76.
- Lee, E.J., Frazier, S.K. (2011). The efficacy of acupressure for symptom management: A systematic review. J Pain Symptom Manage. 42(4). 589–603.
- Werntoft, E., Dykes, A.K.. (2001). Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled pilot study. J Reprod Med. 46(9). 835-9.
- Norheim, A.J., Pedersen, E.J., Fønnebø, V., et al. (2001). Acupressure treatment of morning sickness in pregnancy: A randomised, double-blind, placebo-controlled study. Scand J Prim Health Care. 19(1). 43–7.
- Steele, N.M., French, J., Gatherer-Boyles, J., et al. (2001). Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy. J Obstet Gynecol Neonatal Nurs. 30(1). 61-70.
Dr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at firstname.lastname@example.org.