Women’s bodies change on many levels through each trimester of pregnancy, and these changes sometimes require massage therapists to make adjustments both before and during massage sessions. Even with the need for heightened awareness and a more in-depth understanding of pregnancy, however, an expansive body of research firmly supports massage therapy’s many advantages for pregnant women, which run the gamut from reduced discomfort, anxiety and depression to shorter labors.
Research dating back two decades began to confirm the benefits of massage therapy during pregnancy, with a 1999 study in the Journal of Psychosomatic Obstetrics & Gynecology finding reduced anxiety, improved mood, better sleep and less back pain among expectant mothers who received massage twice weekly for five weeks. Such results don’t surprise experts like Gail Pezzullo-Burgs, M.D., an obstetrician in Boca Raton, Florida, whose practice incorporates massage therapy.
“We’re firm believers in stress-reduction techniques, and massage therapy increases the sense of well-being,” Dr. Pezzullo-Burgs says. “And pregnant women often have complaints of pain and decreased circulation that massage therapy really helps.”
Dr. Pezzullo-Burgs began incorporating massage and other integrative therapies into her practice about six years ago when transitioning into a wellness center approach. “Pain is probably the main thing that drives patients to get massage, such as sciatica from the extra weight or position of the baby,” Dr. Pezzullo-Burgs explains. “People go through pregnancy in different mindsets, and some are more anxious than others, but I think it also helps reduce their anxiety even if they’re not having pain.”
Additional early research added even more insight into massage’s role in facilitating a healthier pregnancy. A small 2006 study in the Scandinavian Journal of Caring Sciences showed massage was a solid integrative treatment for severe pregnancy- related nausea and vomiting, while a 2009 study in the Journal of Bodywork and Movement Therapies on 112 pregnant women diagnosed with depression suggested those receiving psychotherapy plus massage over a six-week period experienced greater drops in depression than those getting psychotherapy alone.
Meanwhile, a 2009 study in Infant Behavior & Development also focused on pregnant women with depression, finding those undergoing massage therapy not only experienced less depression at the end of 12 weeks, but also carried that benefit into the postpartum period. And a 2010 literature review in Expert Reviews in Obstetrics and Gynecology showed massage therapy decreased depression, anxiety, and leg and back pain in pregnant women, also indicating those in labor used less pain medication and had labors averaging three hours shorter than average.
“Women today are often told in their pregnancy they must ‘just deal’ with any ache, pain or discomfort that comes up . . . but this is where massage can help them,” says Kimberly Corpus, an educator in pregnancy and infant massage and massage therapist from Rochester, New York, who frequently works with pregnant clients. She notes that massage can also reduce swelling, lessen sciatic pain and ease insomnia.
“The No. 1 benefit is obviously relaxation,” says Stephen Abate, a massage therapist from Washington, D.C., who has been working with pregnant clients since 2015. “One of the big issues for moms-to-be is sleeping, so it’s a chance to close their eyes and be truly comfortable.”
Comprehensive Intake Process
Why can pregnancy be so physically taxing? Some of the most pervasive changes are due to increased joint mobility from the body’s profuse production of the hormone relaxin to prepare for childbirth. Relaxin has a loosening effect on ligaments all over the body, Corpus explains, making joints more pliable but also increasing their risk of being overstretched.
“Combining relaxin with having the weight of a growing fetus on the front of the abdomen can cause many different painful and biomechanical dysfunctions,” she explains, including an increase in lumbar lordosis. “This causes compensatory shifts in all of the structures both above and below the lumbar spine. It is these compensations, which the body isn’t used to, that are responsible for pain.”
Experts advise a thorough intake process for pregnant clients, documenting factors such as gestational stage, prenatal diagnoses, past pregnancy problems, medication use, prior bodily trauma, exercise habits and prior massage history. Corpus asks clients to update information at each subsequent session regarding blood pressure, medications and other potential changes. Additionally, if a client has any complications, massage therapists should consider requiring a medical release from the client’s physician.
“When you think of how many changes are happening to them and the baby over nine months,” she says, “it’s important to understand what’s happening clinically because we want to make sure we’re giving the safest, most appropriate massage to that woman.”
Massage Modifications or Contraindications
What types of pathologies are associated with pregnancy, and how might they change your approach? Even the most typical complaints resulting from hormonal and structural changes in the body may require modifications. These include:
• Morning sickness: Much evidence indicates massage reduces this highly common issue, says Susan Salvo, Ph.D., a massage therapist from Lake Charles, Louisiana, who presented on pregnancy massage at the 2017 AMTA NationalConvention. She recommends elevating the client’s upper body. “Don’t use techniques that rock or shake her,” she says, adding that it’s wise to keep a vomit bag in the room.
• Heartburn: Prop clients into an incline to ease any reflux, Abate advises. “Propping under the abdomen when they’re in a side-lying position can lift the abdomen, taking tension back from the gastric sphincter, which can alleviate discomfort,” he says.
• Lower back pain: With this prominent issue, working deeply in the lower back helps—but only to a point, Abate notes.
• Varicose veins: Avoid massaging on top of these, experts caution. “Varicose veins can be a sign of blood pooling and potentially a blood clot,” Abate says. “If there are significant varicose veins or swelling in the legs, I won’t do long effleurage strokes up the legs. You can work on just the feet, but don’t work starting from the ankle and gliding up to the hip.”
• Gestational diabetes: Blood sugar levels need to be under control before massage is allowable, experts say. Salvo keeps honey packets handy during a session in case sugar levels drop and sometimes asks pregnant clients to check their blood sugar if they have a glycometer.
• Edema (swelling): Swelling typically occurs halfway through or later in the pregnancy, primarily in the calves and feet, but in the face or hands it can indicate pre-eclampsia, which is marked by a potentially dangerous rise in blood pressure. Normal edema “sometimes is responsive to techniques that will improve the client’s pelvic alignment,” says Carole Osborne, a massage therapist in San Diego, California, and author of Pre- and Perinatal Massage Therapy & Deep Tissue Sculpting.
Only a handful of pregnancy complications are contraindications to massage, experts say.
• Pre-eclampsia: The aforementioned condition, which develops after 20 weeks, can also damage blood vessels and cause stroke or even death. Massage may be performed in affected clients with a doctor’s permission, experts note.
• Deep vein thrombosis (DVT): Salvo checks pregnant clients for DVT by looking for differences between the left and right legs, including swelling or heat in only one. “If you have a DVT diagnosis or have a positive screening, you postpone the massage until it resolves,” she says.
• Placenta problems (including previa, accreta or abruption): These rare conditions involving the placenta can lead to dangerous bleeding. “Postpone the massage or get the physician’s OK,” Salvo advises.
Beneficial Positioning and Techniques
Positioning for pregnant clients should never be an afterthought. The side-lying position is recommended by doctors and midwives to help ensure placental and fetal circulation, Corpus says, and the left side-lying position is safest since it allows maximum cardiac function and fetal oxygenation. Positioning clients on their back can trigger supine hypotensive syndrome, which can leave them feeling dizzy, weak, nauseated and short of breath when blood pressure drops due to compression of the vena cava.
“When they get to about 20 weeks of pregnancy, depending on how large they are, I always massage in the side-lying position because of a drop in blood pressure by putting pressure on the abdominal vessels in the supine position,” Salvo says. “It’s a universal precautions approach: Assume they will have it, and plan for it. Put a rolled-up pillow or towel or baby pillow under the right hip to tilt them to the left.”
Corpus and other experts employ a wide variety of massage strokes on pregnant women, including petrissage, effleurage, compression, feathering, gentle stretching, lengthening and cranial sacral therapy.
“The majority of clients seek massage therapy for pain relief—in particular, pelvic pain,” Osborne says. “Techniques that address the varied structures of the pelvis and lumbar area are probably going to be most beneficial . . . including deep tissue, myofascial work, active and passive stretching, neuromuscular trigger point work and various types of rhythmic movement.”