Pregnancy Massage – What to Expect (When You’re Expecting)

So you have a little one on the way and you've heard that pregnancy massage might be a pretty good thing. Perhaps you have some aches and pains, you haven't been sleeping very well or you just feel like you need to do something to pamper yourself and relax - all excellent reasons to give pregnancy massage a try.

But there can be some anxiety around the actual treatment too. How is my therapist going to position me? Are there any risks to my baby? What if I get the desperate urge to pee halfway through? (Hey, it happens). This blog post aims to try and answer some of those questions, and give you an idea of how your pregnancy massage treatment might change and develop along with your bump.

Note that some of these points might apply regardless of which trimester you're in. For example, if it's your first appointment, a thorough medical history will be always taken, to ensure that the treatment you receive is not only effective, but safe too.

First Trimester

You're expecting a baby! This is wonderful news. Or surprising news. Or downright terrifying news. Or a mixture of all three. Expectant mothers can have many different reactions to the knowledge that they have a little life growing inside them, and emotions can be complicated. As well as this there can be worries about the pregnancy itself - what if something goes wrong? How is my body going to change? Am I going to spend the next three months (or more) gazing into the depths of a toilet bowl? Reducing this sense of anxiety can be one of the most beneficial reasons for getting a pregnancy massage at this time.

How the treatment might look 

Your therapist will first take a detailed medical history from you, including some pregnancy specific questions such as how many pregnancies you've had in the past, any complications you might be experiencing and the details of your prenatal care provider. They will ask how you have been feeling in your pregnancy, what your reasons for getting a massage are and whether you've had any of the common first trimester side effects such as morning sickness, mild dizziness, fatigue or breast tenderness, which will determine if any adjustments need to be made for your particular treatment. If you've got the all clear (i.e. a normal, low risk pregnancy, which will be the experience of the majority of pregnant women) then you're good to go.

In the first trimester, positioning isn't of huge importance. You can still lie comfortably on your front, and even by the end of the first trimester your baby is only 2-3 inches long, so lying on your back isn't a problem either (as your pregnancy develops, lying on your back will grow more uncomfortable as the weight of the baby presses down on the aorta and inferior vena cava). However there may still be some considerations for positioning - if you are experiencing breast tenderness you might prefer not to be on your front for example, or you might feel nauseous if you lie a certain way. Your therapist should be able to adapt to your needs and get you in a position that feels best for you.

As morning sickness is so common during this trimester, your therapist will be sure not to use any scents during the treatment, unless you specifically request them. These include room sprays, scented candles, aromatherapy diffusers, and scented massage oils and lotions. Nausea can often be triggered by certain foods or smells, and there must be nothing worse than lying on a massage table trying to suppress the overwhelming urge to be sick. If you do feel like you want to throw up however, don't be afraid to tell your therapist. They will be completely understanding and some will even keep travel sickness bags in the therapy room, just in case.

Your therapist may work on any part of your body, depending on what your goals are and what was discussed before the treatment. Some women are concerned that certain acupressure points in the ankle and sacral area can stimulate contractions - there is absolutely no evidence to support this idea but talk to your therapist if this is something you're worried about. Abdominal work can be discussed before the start of the massage - certainly deep work into the abdomen is contraindicated, but sometimes gentle, open palmed strokes to the stomach area can be very soothing and might be helpful for constipation, which is another common complaint in pregnancy as the effects of the hormone progesterone kick in and bowels become more sluggish. Although this sort of work won't be harmful to your baby (the uterus won't even have risen into the abdomen by this stage), some women are just uncomfortable with having their belly touched at all during this time, and that's perfectly fine too.

Another issue your therapist will be careful about is the laxity (looseness) of your joints. Due to the hormones relaxin and progesterone, the ligaments around your joints will become more supple than usual. This is ultimately for the greater good - the purpose being to relax the ligaments around your pelvis in order to ease the passage of your baby during birth, which is definitely something to be grateful for. Unfortunately however, these hormones aren't choosey about which ligaments they relax and therefore the possibility of injury to other joints through over-stretching may increase. Because of this, vigorous stretching techniques will likely be avoided, although gentle mobilisations can still be useful, particularly in the case of oedema (swelling) that can occur in the hands and feet later on in pregnancy.

Blood pressure can sometimes fall during pregnancy, due to your blood vessels expanding to accommodate the extra blood needed to support both you and your baby. This makes dizziness more likely, especially when sitting or standing up too quickly. Make sure that you take your time in getting off the table after your treatment, particularly if you experience any lightheadedness.

A lot of pregnant women need to urinate more frequently during the first trimester. If you find you have to go halfway through the treatment, don't be scared to speak up - your therapist would much prefer you were comfortable and relaxed during your massage, rather than counting down the seconds until you can get off the table and run to the loo.

Second Trimester

During the second trimester, many of the worries and discomforts of early pregnancy will hopefully either lessen or disappear completely. The 'danger zone' of the first trimester has passed (most miscarriages happen in the first three months) and if you've been having mood swings or low energy, these should start to level out. In this stage of pregnancy, you might start to develop some leg cramping and slight swelling of the hands and feet, and you should finally start to look pregnant. During this trimester, bodywork can be useful in helping to maintain a good posture - this will be helpful once the weight of the baby starts to pull your centre of gravity forward, increasing your chance of developing back pain.

How the treatment might look

Once your bump begins to show, your therapist will probably start positioning you in a side-lying or semi-reclining position, in order to avoid putting pressure on the uterus or the structures within your abdomen. You may still be able to lie on your back, but your therapist will probably start reducing the time that they keep you in this position - let them know if you start feeling nauseous, dizzy or uneasy. Some therapists may use special body cushions in order for you to to continue lying on your stomach - if so, communicate with your therapist if you start feeling uncomfortable, as this position may cause some pulling on the uterine ligaments, or just not feel 'right' for some women.

The increase in circulation and blood volume may mean that you start to feel warmer. Your therapist should be conscious of this and ensure the treatment room isn't too warm - they may have a fan in the room to help circulate air and keep you cool. Communicate with him or her if the temperature isn't right for you, and ask for a drink of water if you start to feel too warm or dehydrated.

If you're starting to experience any swelling in your hands and feet, your therapist can do some mobilisations or lymphatic drainage techniques to try and get the fluid moving again. Similarly, if you have any nasal congestion, ask if your therapist can do some gentle facial massage at the end of your treatment, to try and clear the sinuses and making breathing easier.

This is also the trimester where leg cramps can start to become an issue for some women. Your therapist will ensure that your calf muscles are not kept in a shortened position (as they would be if you pointed your toes, for example). If you do experience any cramping, get your therapist to gently stretch out your calf muscles, holding the stretch until the cramp has eased.

The second trimester is also the time when varicose veins may become more pronounced. Your therapist should never massage directly over the vein, although some gentle work above and around the vein can be done to help the general circulation of the area. Your therapist will probably also avoid deep work to the adductor area (the inside of your thighs) - although its rare, pregnant women are at a higher risk of developing blood clots in this area, and deep work has the potential to dislodge them.

Your therapist may start to do some postural awareness exercises with you, in order to lessen some of the aches and pains which are common later on in the third trimester. These may include myofascial release on the lower back, pelvic tilting and spine lengthening exercises, as well as work on the breath and intercostals (the muscles in between the ribs) to keep the ribcage open and free, which will be helpful in the latter stages of pregnancy when your baby starts to press up on your diaphragm and shortness of breath is a common symptom.

Third Trimester

During this trimester, your baby is primarily focussed on putting on weight and getting bigger. This can be the most physically demanding phase of pregnancy, as you heft around an extra five or so kilos of baby weight. Your pelvic ligaments loosen up in preparation for the birth, and you may experience some pain in either the symphasis pubis (the joint at the front of your pubic bone) or sacroilliac joint (where your sacrum meets the two major bones of your pelvis). Sciatic type symptoms may develop which come and go, with pain in the lower back which may travel down into one of your legs.

Shortness of breath is another issue in the final three months of pregnancy, as your baby grows bigger and starts to push up into your ribs. Oedema and leg cramps may increase, and you may start experiencing braxton hicks contractions, in preparation for labor. You are likely to start feeling fatigued again, and anxiety can increase as the birth draws closer. Bodywork in this stage of pregnancy can help ease the discomfort by doing work on the ribcage to make breathing easier, aid backache, help the circulatory and lymphatic systems to get fluids moving properly and ease the feelings of anxiety and tiredness.

How the treatment might look 

At this stage, all the work your therapist does should be in a side-lying, semi-reclined or sometimes seated position. If there is any work done lying on your back, it shouldn't be for longer than 5 minutes or so to avoid compressing the major veins and arteries that run through the abdomen. You may have difficulty getting on and off the massage table - if so a step should be provided to make it easier for you.

You might find that you struggle to get comfortable in any one position - if this is the case, you and your therapist can work together to ensure your comfort throughout the session, changing positions when necessary. You are likely to need to use the bathroom more again in the third trimester as your baby presses against your bladder and other internal organs and your therapist should allow for this, as well as help you on and off the table if necessary.

Much of the work in this trimester will be focussed on creating a feeling of space within your body - helping to ease the stresses on your spine, ribcage and pelvis, which become compressed by the size and weight of your baby. Work might be done to try improve circulation and lymphatic flow, which can become somewhat blocked at this time, causing swelling at the joints of the hands and feet, carpal tunnel syndrome and congestion in the sinuses. Facial massage can be a useful add on to the end of a massage to try and relieve some of this congestion.

You're likely to be experiencing some lower back pain at this stage, as the weight of your baby pulls you forward, tilting your pelvis forward and down. If you haven't already been doing any postural awareness exercises, now is a good time to start. You might also find some good, firm work on your lower back and sacrum area very relieving.

Don't be scared to tell your therapist what you want at the start of the session - this might vary from week to week depending on your mood and level of tiredness. Sometimes you might want a good firm massage to get rid of tension in achey muscles, and other times you might want just light, soothing strokes in order to relax you and relieve any anxiety you might be experiencing. Your therapist wants you to enjoy your massage - so get comfortable with being demanding!

Your partner might want to get involved in your massage sessions, and your therapist can show him or her some techniques which they can use to help make you feel more comfortable at home and during labor. These sessions can be a great way for you and your partner to learn to work together for the common goal of the birth of your baby, and support the transition of going from a couple to being a family.

By now hopefully you should have a clearer idea of what do expect when going for a pregnancy massage, and have a better sense of what this type of therapy can offer you through all stages of your pregnancy. If you have any other worries or concerns, phone your potential therapist for a chat - they will be more than happy to assist you.

Pregnancy massage can be a fantastic supplement to a healthy pregnancy, which can benefit mums-to-be both emotionally and physically. Make sure you check with your midwife or obstetrician before embarking on any new therapeutic practice.

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