Pregnancy Massage: The 3rd Trimester

Pregnancy massage is modification of techniques and body positions to meet the needs of women as they undergo changes during pregnancy & the postpartum period.  This blog discusses massage during the third trimester, which is week 29 to birth, which is around week 40. After presenting research on massage and labor, we will discuss conditions more common in the third trimester including heartburn, lower back pain, edema, varicose veins, and stretch marks.

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

As reminder, pregnant clients in their third trimester can lie in the prone position using a specially designed massage table with recesses or using bolstering systems that lie on the tabletop.

When massage therapy was used during labor, labors were, on average, 3-hours shorter in duration & there was less need for medication (Field, 2010). Women had fewer complications and their infants had fewer postnatal complications such as prematurity (Field et al, 1999). Reflexology reduced labor pain intensity (Moghimi-Hanjani et al, 2015, Valiani et al, 2010), decreased labor pain duration, & reduced anxiety in women giving birth for the first time (Moghimi-Hanjani et al, 2015).

Heartburn – Heartburn is a burning sensation in the chest behind the sternum. This sensation is often experienced in the area near the heart, hence the name heartburn, but the discomfort can extend to the lower throat. Heartburn is also associated with gastroesophageal reflux disease (GERD) or periodic regurgitation of gastric contents into the esophagus. An enlarged uterus may cause heartburn as it crowds internal organs. The hormone progesterone relaxes smooth muscle in the uterus & may also relax the lower esophageal sphincter, allowing gastric juice to enter the lower portion of the esophagus. Progesterone also slows down digestion by decreasing intestinal motility.

Massage and Heartburn – If your pregnant client has heartburn, the Mayo Clinic (2018) recommends waiting 3 hours before lying down after consuming a meal. Discuss this with your client & consider scheduling the massage appointment accordingly. If this is not possible, the Mayo Clinic (2018) also recommends elevating the upper body in a semireclining position while lying supine to reduce heartburn symptoms. Be sure to place a small cushion beneath her right hip while she is supine to help move her pregnant uterus off abdominal blood vessels & reduce the risk of supine hypotensive syndrome. A seated position can also be used.

Lower Back Pain – As the uterus grows & extends forward, the pregnant woman may lean backward to compensate for the added girth, especially while standing and walking. This postural change may tilt her pelvis anteriorly, placing stress on the lumbar spine & sacroiliac joints.

Massage and Lower Back Pain – Spend extra time on her lumbosacral & buttocks areas. This may offer temporary relief from pain. Another contributing factor of lower back pain is referred pain from overstretched uterine ligaments, such as the broad & round ligaments. In fact, she may experience sudden brief pain while repositioning herself or while getting on or off the massage table. When this occurs, suggest that she lie back down slowly and remain there until the pain subsides. After a few moments, ask her to try again, moving more slowly this time.  

Edema in Legs, Ankles, and Feet –Edema, or swelling, may occur in the feet & ankles as fluid volume increases by up to 50% during the third trimester & as an enlarged uterus presses against blood vessels that supply the lower extremities. Edema tends to be more severe at the end of the day & during summer months. While some swelling is normal in pregnancy, widespread swelling may be a sign of preeclampsia, a condition requiring immediate referral to her obstetrician or health care provider who is managing her pregnancy.

Massage and Edema in the Feet/Ankles – For localized edema, place the affected area on cushions to raise it above the level of the heart. Use light pressure effleurage applied centripetally and skin stretching. Massage proximal to the affected area first and then proceed distally (e.g., massage the thigh, then the leg, then the ankle, and the foot last) as lymph moves toward the groin in the lower extremities. The recommended pressure to move lymph is approximately 5 grams of pressure or about the weight of a nickel (Shepard, n.d.). CAUTION: Mild swelling of the legs, ankles, and feet during pregnancy is normal and not a contraindication for massage. However, unilateral swelling or widespread swelling requires referral made to the client’s obstetrician or healthcare provider managing the pregnancy. Unilateral leg swelling, especially in the presence of heat, redness, pain, and tenderness, could indicate DVT. Generalized edema could be a sign of preeclampsia. Both cases require a referral made to the client’s healthcare provider.

Research. A 20-minute foot massage administered for 5 consecutive days reduced lower leg edema in women during late pregnancy (Coban & Sirin, 2010; Navaee & Rakhshkhorshid, 2020). Bamigboye and Smyth (2007) conducted systematic review and found reflexology may help reduce leg edema during pregnancy.

Varicose Veins – Varicose veins are dilated veins due to incompetent valves. Women may develop varicose veins during pregnancy or find that varicose veins present before pregnancy worsen. A heavy uterus pressing on nearby blood vessels may increase pressure in veins located in the lower extremities. Blood volume also increases during pregnancy, which may add to the burden on an already compromised venous system. Progesterone relaxes smooth muscles, & dilates peripheral blood vessels, which contributes further to varicose veins.

Massage and Varicose Veins – Avoid the affected area while she is pregnant & for 10 weeks postpartum because of the increased risk of blood clots  or deep vein thrombosis.

Stretch Marks – Stretch marks are a skin injury from tearing, thinning, or overstretching of skin, which reduces its thickness. They are most commonly located on the breasts, hips, thighs, buttocks,& abdomen. Approximately half of all pregnant women acquire stretch marks related to pregnancy weight gain. Stretch marks start out pink, reddish brown, or very dark brown, depending on the color of her skin, and later fade although they never completely disappear.

Massage and Stretch Marks – Use light pressure over stretch marks. Massage will not reduce stretch marks, because they are areas of overstretched, thinned skin rather than scar tissue.

Picture Credits:

http://www.nubospa.com/prenatal-massage-berkeley-ca/

Stillerman E: Prenatal massage: a textbook of pregnancy, labor, and postpartum bodywork, St Louis, 2008, Mosby.

References:

Bamigboye, A.A., Smyth, R. (2007). Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database of Systematic Reviews, 24(1), CD001066.

Coban, A., Sirin, A. (2010). Effect of foot massage to decrease physiological lower leg oedema in late pregnancy: a randomized controlled trial in Turkey. Int J Nurs Pract, 16(5), 454-60.

Field, T. (2010). Pregnancy and labor massage. Expert Rev Obstet Gynecol. 5(2). 177–181

Field, T., Hernandez-Reif, M., Hart, S., et al, (1999). Pregnant women benefit from massage therapy. J Psychosom Obstet Gynaecol. 20(1). 31-8.

Mayo Clinic (2018). Heartburn. Retrieved from https://www.mayoclinic.org/diseases-conditions/heartburn/diagnosis-treatment/drc-20373229

Moghimi-Hanjani, S., Mehdizadeh-Tourzani, Z., Shoghi, M. (2015). The effect of foot reflexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Med Iran.53(8). 507-11.

Navaee, M., Rakhshkhorshid, M. (2020).Comparing the effect of foot massage with grape seed oil and sweet almond oil on physiological leg edema in primigravidae: a randomized clinical trial. Evidence-based Complementary and Alternative Medicine, Article ID 6835814, 1-6.

Shepard, J. (n.d.). What is lymph drainage therapy: What does it offer? Retrieved from https://chiklyinstitute.com/sites/default/files/articles/What%20is%20Lymph%20Drainage%20Therapy%3B%20What%20Does%20it%20OfferJane%20Shepard%2C%20M.Ed_.%2C%20L.L.C.C%2C%20New%20Visions%20Magazine%2C%202001.pdf.

Valiani, M., Shiran, E., Kianpour, M., et al. (2010). Reviewing the effect of reflexology on the pain and certain features and outcomes of the labor on the primiparous women. Iran J Nurs Midwifery Res. 15(Suppl 1): 302–10

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 susansalvo@hotmail.com.