Part 5 of 6. Pregnancy massage is modification of techniques & body positions to meet the needs of women as they undergo changes during pregnancy & the postpartum period. The postpartum period begins after childbirth & extends for approximately 6 weeks. The American Pregnancy Association supports the use of postpartum massage, listing some of the benefits as increasing relaxation, lowering anxiety, depression, pain, reducing swelling, & improving sleep (1). Remember to screen for DVT until week 10 postpartum.
Vaginal Births – Approximately 70% of childbirths in the United States are vaginal deliveries according to the National Center for Health Statistics (2). Most women go home within 36 to 48 hours after childbirth unless there is a complication.
Massage Therapy & Vaginal Births – Position your client for comfort, which may include extra support for her breasts while in the prone position. The uterus will return to normal size relatively quickly with massage focused over the lower portion of the abdomen (also called fundal massage) every 4 hours for 10 days to 2 weeks after childbirth. Encourage her to massage her own lower abdomen during this time.
Cesarean Births – Some childbirths are Cesarean, or C-section, which is a surgical procedure that removes the child or children through the abdominal wall. Approximately 30% of childbirths in the United States are Cesarean deliveries according to the National Center for Health Statistics (2). Most women remain in the hospital for three days; this may be longer if there are complications.
Massage Therapy & C-Sections – Massage therapy can begin after major surgery once the client is medically stable. Be sure to communicate with the patient care coordinator if the client is still under medical supervision & follow his/her directives. Position the client for comfort. A side-lying position may be needed to avoid pressure on areas containing recent incisions or drain tubes. The incision, or cut produced by surgical instruments during the operation, and areas near the incision should be avoided until the sutures or staples are removed & the area is clean and dry, not moist or open. This may take up to 8 weeks after surgery. In addition, the area around the incision should not be manipulated in a way that places stress on the incision while it is healing. Once healed, massage of the scar tissue can begin.
Avoid vigorous massage techniques on the lower extremities (thighs and legs) for 12 weeks after surgery. This restriction is due to the increased risk of blood clots, which could last up to 3 months after surgery (3). One exception to this rule is if the client was given heparin or a similar anticoagulant or blood thinner after surgery. In this case, check with the client’s surgeon or pharmacist to determine when vigorous massage techniques can begin on the lower extremities.
Breastfeeding – Breastfeeding is feeding the baby at the breasts. The CDC found that 77% of new mothers are breastfeeding (4). And almost half of breastfeeding mothers continued to do so for at least the recommended six months. Breast undergo many changes during pregnancy and during the lactation period.
Massage Therapy & Breastfeeding – Offer the nursing mother water before & after the massage because her fluid needs increase during this time. Her breasts may be sore and tender, & she may feel more comfortable in a side-lying position during the massage. Be sure to address tension in her back, neck, shoulders, & arms, which may be tight from holding the baby during feedings. If the early postpartum nursing mother is experiencing noninflammatory breast pain, consider recommending self-breast massage as massage relieved & improved newborn suckling (5).
There are several options you can use to help make your new mother more comfortable while she is lying prone. You may offer her a rolled-up towel or cylindrical pillow placed under, above, or between her breasts, whichever is most comfortable. Many clients prefer a supportive device both above & below the breasts. Use a face rest that can be adjusted above the level of the table. Several manufacturers now offer massage tables fitted with breast recesses that allow the client to lie prone more comfortably or offer specially designed bolstering systems that lie on the table top. A side-lying position may be more appropriate if she is uncomfortable lying prone.
Contact or occupational exposure to human breast milk does not pose any health risk to the therapist. The CDC does not list human breast milk as a body fluid that requires special handling precautions (unless there is frequent exposure such as persons working in a milk bank) (6).
CLINICAL TIP: Teach Parents & Caregivers Infant Massage – Infant massage can support the parents’ early involvement in nurturing their baby. Baby’s LOVE massage. View this video for a sample infant massage routine.
** The next blog will discuss the massage therapy and postpartum depression. **
Articles and Journal Referenced:
- Ahn, S., Kim, J., Cho, J. (2011). Effects of breast massage on breast pain, breast-milk sodium, and newborn suckling in early postpartum mothers. J Korean Acad Nurs. 41(4). 451-9.
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 email@example.com.