Part 3 of 6. Pregnancy massage is modification of techniques and body positions to meet the needs of women as they undergo changes during pregnancy and the postpartum period. This blog discusses the second trimester, which spans week 15 to week 28. The massage therapist needs to consider positional modifications as well as avoiding certain hydrotherapy procedures during pregnancy. The second trimester is also when most cases of preeclampsia and gestational diabetes occur.

A recap on the side lying position for pregnancy massage can be found HERE.

During the second trimester, the massage therapist needs to consider positional modifications to reduce the likelihood of supine hypotensive syndrome, and cautions when using hydrotherapy. Also discussed are preeclampsia and gestational diabetes.

Supine Hypotensive Syndrome Supine hypotensive syndrome is a drop in blood pressure as the pregnant uterus compresses major abdominal blood vessels, especially the inferior vena cava. This compression while in the supine position may cause a sudden drop in blood pressure, hence the phrase “supine hypotensive.” Symptoms of supine hypotensive syndrome include dizziness, shortness of breath, nausea, and agitation.


free-massage-clipart-1Massage Therapy and Supine Hypotensive Syndrome – Use a modified supine position from about week 22 to prevent supine hypotensive syndrome. Place a small cushion beneath her right hip to tilt her body toward the left. This elevation of the right hip moves the uterus off the abdominal blood vessels. This modification should also be used in the third trimester while the pregnant client is in the supine position.




Preeclampsia – Preeclampsia, also called pregnancy induced hypertension or PIH, is persistent high blood pressure with protein in the urine that develops after 20 weeks of gestation and returns to normal levels after childbirth. The most common sign is widespread edema. If left untreated, preeclampsia can lead to damaged retinal and/or renal blood vessels, as well as compromised fetal blood flow, liver abnormalities, and bleeding disorders. Preeclampsia occurs in 5% to 8% of all pregnancies. This condition is more common in first pregnancies, many prior pregnancies, and young or advanced maternal age. It is also more common in women who are pregnant with multiple babies. Eclampsia is a severe form of preeclampsia that involves convulsions or seizures. 

The classic triad of symptoms includes hypertension, sudden weight gain with edema (primarily in hands, feet, and face), and protein in the urine. Women with eclampsia will also have convulsions (seizures and/or coma). Some pregnant women with severe preeclampsia or impending eclampsia have headaches, dizziness, spots before the eyes (floaters), abdominal pain, nausea, and vomiting.

Mild cases are addressed with bed rest and monitoring of the mother and baby (sometimes in a hospital). Moderate cases may require medication to control hypertension and reduce the risk of convulsions. The ultimate cure for both preeclampsia and eclampsia is delivery of the baby (or babies).

free-massage-clipart-1Massage Therapy & Preeclampsia – Screen your clients for preeclampsia starting at week 20. If you notice widespread edema, postpone massage and refer her to the obstetrician or health care provider who is managing her pregnancy for evaluation and possible treatment. This restriction is true for the third trimester.

Gestational Diabetes MellitusGestational diabetes mellitus (GDM) is a form of glucose intolerance that develops in some women during pregnancy, most often during the second trimester. Women diagnosed with GDM have a 50% chance of developing diabetes later in life. Fetal complications related to GDM include excessive growth, respiratory distress syndrome, diabetand premature birth. Gestational diabetes mellitus is also called gestational glucose intolerance. Some women are asymptomatic, whereas others have sugar in the urine, excessive urination, excessive thirst, and excessive hunger. Malaise and blurred vision may also be present.

Most pregnant women are screened in the second trimester—earlier if risk factors are present. If a pregnant woman tests positive for GDM, treatment usually consists of monitoring blood sugar, proper nutrition, and regular physical activity. If these measures are not sufficient to lower blood sugar, insulin may be prescribed. The latter occurs in 10% to 20% of GDM cases.

free-massage-clipart-1Massage Therapy & Gestational Diabetes Mellitus – Postpone massage until the condition is well managed (health care provider-determined).

At this time, proceed using the aforementioned guidelines for pregnancy massage. Avoid vigorous massage and heat/ice applications over sites of recent subcutaneous injections for 24 hours. Massage therapy was found to increase insulin absorption administered by subcutaneous injection (1,2). The increased absorption produced by massage could cause or contribute to complications such as hypoglycemia. Be sure and ask the client if she carries a glucose meter or glucose tablets or gel and, if so, where they are in case they are needed during a possible hypoglycemic episode.

free-massage-clipart-1CAUTION: Pregnancy and Hydrotherapy – Pregnant women should not use hot immersion baths and hot packs applied to the lower back and abdomen. The unborn may be injured by maternal hyperthermia.


** The next blog will discuss massage therapy during the third trimester. **

Picture Credits:


Articles and Journals Referenced:

  1. Berger M, Cuppers HL, Hegner H, et al. (1982) Absorption kinetics and biologic effects of subcutaneously injected insulin preparation, Diabetes care, 5(2):77–91.
  2. Linde B. (1986). Dissociation of insulin absorption and blood flow during massage of a subcutaneous injection site. Diabetes Care, 9(6):570–74.


Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at