Pregnancy and Massage

Pregnancy often brings life transitions and a new set of challenges. During this time, women experience anatomical, physiological and psychological change. 

Pregnancy is often depicted as a joyful nine months, but the physical reality of gestating another human being often includes a myriad of complaints that can usually benefit from a massage therapist’s expertise.

Knowing how massage therapy best helps women who are pregnant – as well as the cautions and contraindications that will help guide every massage session – is necessary for therapists who want to work with these clients. Even with the need for increased awareness and a more in-depth understanding of pregnancy, there is an expansive body of research that supports massage therapy’s many advantages during the prenatal, labor, and postpartum periods.

Pregnancy Massage Benefits include:

  • Alleviating back + leg pain
  • Reducing labor pain during childbirth
  • Lessening postoperative pain
  • Reducing anxiety + stress
  • Improving mood + lifting depression
  • Easing insomnia

Research That Supports Massage for Pregnancy

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.

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.

In addition, massage therapy has been shown to play a critical role in newborn care. Clinical trials indicate that infants born to mothers who had massage therapy had lower cortisol levels, better neonatal outcomes and fewer incidences of low birth weight and prematurity.

Related Online Continuing Education Course

Explore how massage therapy can provide benefits throughout a women’s pregnancy in AMTA’s NCBTMB-approved online CE course.

Pregnancy and Massage Online CE Course by Susan Salvo

$45.00 members / $75.00 nonmembers    3 CE credits

Learn how pregnancy, childbirth, and the postpartum period affect women. Understand the problems that can occur and the appropriate massage techniques for each phase. Recognize contraindications and specific needs for those with high-risk pregnancies.

Register Now

Comprehensive Intake Process

Experts advise a thorough intake process for pregnant clients. The following factors should be documented during this process:

  • Gestational stage
  • Prenatal diagnoses
  • Past pregnancy problems
  • Medication use
  • Prior bodily trauma
  • Exercise habits
  • Prior massage history

In addition, you should ask clients to update information at each subsequent session regarding blood pressure, medications and other potential changes. And, if a client has any complications, massage therapists should consider requiring a medical release from the client’s physician.

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. It’s recommended to elevate the client’s upper body and avoid using techniques that rock or shake.

  • Heartburn: Prop clients into an incline to ease any reflux. Propping under the abdomen when clients are in a side-lying position can lift the abdomen, taking tension back from the gastric sphincter, which can alleviate discomfort.

  • Lower back pain: With this prominent issue, working deeply in the lower back helps—but only to a point.

  • Varicose veins: Avoid massaging on top of these, experts caution. Varicose veins can be a sign of blood pooling and potentially a blood clot. If there are significant varicose veins or swelling in the legs, avoid doing 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. You can ask 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. 

Pregnancy Contraindications to Massage

The following are pregnancy complications which are contraindications to massage, according to experts:

  • Pre-eclampsia: This 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): Check pregnant clients for DVT by looking for differences between the left and right legs, including swelling or heat in only one. If there is a DVT diagnosis or a positive screening, the massage should be postponed until it resolves.

  • Placenta problems (including previa, accreta or abruption): These rare conditions involving the placenta can lead to dangerous bleeding. The massage should be postponed unless a physician okays it.

Positioning and Techniques

Positioning for pregnant clients is important. The side-lying position is recommended by doctors and midwives to help ensure placental and fetal circulation, 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.

Experts employ a wide variety of massage strokes on pregnant women, including petrissage, effleurage, compression, feathering, gentle stretching, lengthening, and cranial sacral therapy. Other techniques that address the varied structures of the body are probably going to be the most beneficial, including deep tissue, myofascial work, active and passive stretching, neuromuscular trigger point work and various types of rhythmic movement.