“Massage Issues Unique to the Pregnant Client”
By Leslie Stager, RN, LMT. Leslie developed and teaches the Maternity Massage Certificate program at Oregon School of Massage.
For 10 years, a friend of mine had a very busy, full-time sports massage practice. She sometimes saw pregnant clients and worked with them similarly to how she worked with her non-pregnant clients; often they required deep work to the hip adductors, hamstrings, and quads. One day we had a conversation about our respective work. She asked what topics I teach in the Pregnancy Massage Essentials class. I described that we explore sidelying and semi-reclining positioning, draping and body mechanics in those positions, A&P of the perinatal cycle and how that impacts bodywork, postural issues, and precautions, amongst many other topics.
“What kind of precautions?” she asked.
I mentioned the 5 x increased risk of blood clots in pregnancy, and the even greater increased risk in the postpartum period, and the importance of great care if working the inner thighs and adductors (which is generally contraindicated during pregnancy & early post-birth). I shared about the affects of progesterone during pregnancy, which can increase postural hypotension and potential lightheadedness when a woman sits up after a session. We talked about diastasis of the rectus muscles and pubic bones, how to identify that, and the importance of proper positioning in sidelying to avoid strain on the uterine and sacral ligaments, and how that can be confused with sciatica. All this new information would impact her work. She realized she had made many assumptions about pregnant clients that were inaccurate.
Twice she had a client whose bag of water broke while on her table. She had been very nervous about how to handle that when it occurred, and wondered if she had caused it. Based on the kind of work she was doing, and how she had her client positioned, I could see that there might be some question about that. The story reminded me of another friend who had a 1st trimester pregnant client who miscarried a day after her massage. This friend actually quit her massage practice then, believing that she may have caused the miscarriage. She never spoke to the client again, and lived for decades (until we talked about it) believing she had caused the miscarriage. I assured her that her type of massage would not cause one to occur, and shared about realities of the frequency of miscarriage in the first trimester.
Bodyworkers might be working with pregnant clients as if they are just like their non-pregnant clients. I was recently at an acupuncturist office where the 40-week pregnant client was positioned flat on her back for a 40 minute session, without assessing her comfort level. There are many instances where a minor (and sometimes major) adjustment will drastically improve the safety and comfort level for a pregnant client. If you don’t have the awareness about their needs and conditions however, you may never think to offer it.
You don’t have to become a pregnancy massage specialist to realize you need to learn more about pregnancy related bodywork to make your practice safer and more effective.
LESLIE STAGER RN, LMT, has been a leading, internationally known Perinatal Massage specialist since 1993. She returns to OSM in November offering a series of classes: Essentials of Pregnancy Massage (Nov 1-3), Massage & Acupressure for Birthing (Nov 8), Advanced Pregnancy Massage (Nov 9), and Bodywork for the New Mother (Nov 10).