Prenatal Health Through Massage Therapy: For Women and Their Babies
Julie Howell, N.M.T., P.M.T., details the benefits and debunks the myths about massage for the expecting.

Sidebar: The Sacral Press: An Assisted Pelvic Tilt

While massage therapy has reached the mainstream, a clear understanding of massage for prenatal women has not yet found its place in American culture. Twenty years ago, medical doctors believed pregnancy was an automatic contraindication for massage and women were expected to just wait out the various (and sometimes excruciating) muscular pains of pregnancy. For the general public, myths based in truth found a life of their own ("I heard you should never let anyone touch your feet…") and grew to urban legend proportion.

Through the efforts of pioneers in the field like massage therapist Carole Osborne-Sheets and medical doctor Tiffany Fields, great strides have been made in the arenas of research, teaching and practice. This is now in the era of communicating that information to both expectant mothers and their health care providers. Research has shown massage to be greatly beneficial, and on the whole, very safe for pregnant women if provided by a trained and experienced practitioner. You may be surprised to know that the developing baby benefits as well.

The Bountiful Benefits of Pregnancy Massage

Emotional Nurturing. Pregnancy is an exciting and anxious time for most women, a time of transition and metamorphoses. For some this is even experienced as a rite of passage into a new form of womanhood. The connection between the emotions--dare I say soul--and the body are very strong throughout this time. The emotional nurturing and centering that happens during massage cannot be undervalued for women who commonly feel a new vulnerability and lack of control in their life, not to mention the sweeping tide of pregnancy-related hormones. For the medically minded, let it be noted that massage produces endorphins, lowers catecholamines (stress hormones), and can lower blood pressure.

Reduced Back Pain. As a fetus grows in utero the woman's muscular and skeletal systems instinctively adjust to her new center of gravity. The muscles used to keep her upright begin to work harder as the pregnancy progresses, creating a buildup of lactic acid and other toxins. Those toxins adhere muscle fibers together, which in turn irritates the nerve endings and causes pain. Massage relieves that pain by gently breaking up the adhesions, releasing trigger points caused by irritated nerve bundles, and pushing circulation into the area to increase oxygen and flush out toxins. The lumbar pain caused by postural distortion is a commonly known example of this, but many women are taken by surprise by upper back pain in the first trimester resulting from a sudden increase in breast size.

Reduced Joint Pain. The weight of the baby and an increase in blood volume, interstitial fluid (edema or swelling) and intrauterine fluid combine to add significant pressure on the hip, knee and ankle joints of expecting women. In addition, the increase in production of the hormone relaxin (which the body uses to prepare for labor) causes a loosening of the connective tissue around those joints and creates instability. Massage reduces edema and creates circulation around those joints to reduce pain.

Reduced or Eliminated Sciatica Pain. Though not the classical diagnosed sciatica in the majority of cases, "pregnancy-induced sciatica" is pain radiating from the low back down one leg. This pain can be so severe as to prevent walking. Usually this is a result of specific muscles adapting to the new pregnancy posture that successfully keeps a pregnant woman upright but simultaneously compresses the sciatic nerve. Massage simply loosens those muscles and releases pressure on the nerve. As a therapist it is emotionally rewarding to help a women with pregnancy-induced sciatica. Many of them are still told by their doctors, "The baby is sitting on the nerve and there is nothing you can do." In my experience, only a few of the women receiving massage for this do not experience relief and for them that might in fact be the baby, but rarely is this the case.

Benefits for Baby
In 1999 Dr. Tiffany Fields at The Touch Institute at the University of Miami published research results showing that pregnant women who received massage experienced reduced anxiety, improved mood, reduced back pain, and (very precious to the pregnant) increased sleep. The massaged women had fewer complications in labor and fewer premature babies. While research is ongoing in this area, it may be that massage is effective in reducing the stress-related hormone cortisol, which is one indicator of premature infants.
Prenatal massage may go beyond preventing prematurity, however. In his recent writings, Dr. Fredrick Wirth, a neonatologist at Tufts University School of Medicine, believes that maternal stress on the fetus actually changes the way the baby's brain is developed. Studies show that expectant moms with high stress levels have aggressive, emotionally underdeveloped children, whereas moms who actively work to decrease their stress have babies who are easily calmed and children who socialize well with others. Massage therapy is an excellent way to reduce stress and actively practice a deeper level of relaxation.

Cautions
There are a few conditions under which women should receive modified massage or avoid massage entirely. Any woman who is considered high-risk should get her obstetrician or midwife's approval before receiving massage. The following high-risk conditions that affect the use of massage include:
· Signs of undiagnosed pregnancy-induced hypertension (PIH) including rapid weight gain, pitting edema, severe headaches, mid-back pain on right side and visual disturbances. If PIH is diagnosed and managed, massage actually reduces blood pressure. If undiagnosed, this condition can be potentially dangerous to mother and child and she needs to go immediately to the hospital.
· Previous pre-term labor requires massage that avoids the abdomen and the ankle area entirely.
· Severe swelling with sudden onset is usually a warning sign of PIH, and you should be seen immediately by your health care provider. It differs from typical pregnancy swelling in its speed of onset and "pitting" quality where pressure to the swollen area leaves a dimpled mark for longer than about 10 seconds.
· Varicose veins are to be avoided but do not prevent massage in other areas.
· For most postpartum women, massage is a great way to speed healing. Massage needs to wait until after care from a provider for the following symptoms: severe bleeding one or two weeks following birth; fever (a sign of possible infection); and mastitis.

Pregnancy Massage: Fact or Myth

Myth: Pregnant women can receive a massage face down if the table has a hole for the belly.
Fact: Massage for the expecting should always be given in side position. 1-3% of all pregnant women have placental disorders and in rare cases undue pressure on the abdomen causes miscarriage. The hole is never one-size-fits-all, so the abdomen will either hang through and strain the uterine ligaments or it will cause pressure the sides of the belly. (Please note: there are no reported cases of a massage causing miscarriage in any position, but because we know of the potential harm of abdominal pressure the tables with holes are to be avoided.)

Myth: Pregnant women should never have their feet or ankles massaged.
Fact: There are acupressure points that are known to stimulate contractions, but only if worked specifically and accurately. Gentle Swedish massage to assist with edema or joint pain is safe for most women. The exception to this is women who have had or are having pre-term contractions, in which case the ankles should be avoided entirely just in case.

Myth: Pregnant women should never get a massage in the first trimester.
Fact: There is no physiological reason to skip massage in the first trimester. Some day spas will refuse to see a woman in her early pregnancy simply because the statistical chance of her miscarrying is greater and they wish to avoid any liability the woman may, in her distress, place on them. At this stage, however, the uterus is still only the size of a plum and therefore protected by the bony structure of the pelvic cavity.
With all the myth and misinformation floating around out there, it begs the question:

How Do I Find A Qualified Pregnancy Massage Therapist?

Trust is an important element in the client/therapist relationship for all people; for pregnant women it is paramount. As they seek to nurture the life within them, women want to make educated choices about how to relieve their discomfort without putting the baby at risk. Finding a therapist who fits the following parameters will guide you in your search:

· Find a member of the National Association of Pregnancy Massage Therapists at www.napmt.com
· Look for a therapist who has studied under national experts such as Carole Osborne-Sheets (phone: 800-586-8322 or email: COS9@aol.com) Kate Jordan (phone: 619- 457-1314 or email: kjordannctmb@aol.com).
· Interview a potential therapist before scheduling an appointment. Ask about additional certification above and beyond what they were taught in massage school. Find out how long she/he has been certified, approximately how many pregnant women with whom she has worked (10 is different than 100 in terms of experience), and how she positions pregnant clients. Ask about your specific concerns and how they might address them. A certified and experienced therapist is a good start. If she also seems confident in her ability to help and there is a sense of personal connection, she is probably a good choice.

Clearly, massage during pregnancy is truly effective for pain relief and promotion of good health for women and their developing babies. As meaningful as this is, it is even more exciting to realize that in the short time prenatal massage has been explored, we may have only touched the tip of the iceberg. Who knows what other benefits will be attributed to massage when more research is focused on this timeless healing art?

Julie Howell, NMT, PMT is a pregnancy massage specialist and the director of The Pregnancy Massage Center in Atlanta, Georgia. She can be contacted at 770-612-0012 or www.pregnancymassage.com.

SIDEBAR:

The Sacral Press: An Assisted Pelvic Tilt

This technique is helpful throughout pregnancy as well as during labor contractions. With a partner's assistance the muscles can be passive, allowing for a more productive stretch of the main low back muscle (quadratus lumborum) and the connective tissue surrounding the sacrum.
Ask the pregnant woman to lie on the edge of a bed on her right side, with pillows under her bent top leg, bottom leg straight. Stand close to the edge of the bed in a deep lunge, your right foot forward, your body facing her feet. Find her sacrum by tracing light fingers to the end of her spine to the flat, triangular bone at the end. (Never apply pressure directly on the spine or the lowest part of the sacrum, known as the coccyx or tailbone.) Use your right hand in a gently curled fist or the flat of your hand to apply pressure to the sacrum, down and in, so that the pelvic area curves forward into a pelvic tilt. You may want to gently hold her hip with your left hand to prevent pushing her over. Hold for thirty seconds and slowly release, and then repeat three or four times. Repeat with her lying on her left side. This technique should always feel wonderful; if there is any discomfort stop immediately. Let her verbal feedback and your sense of touch guide you about location and pressure and she will be a very happy woman.

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