Co-authored by Julia Monorchio of Nurturing Nomad

Pop Quiz: What do you know about massage during pregnancy?

 

In the last 20 years, massage therapy has grown immensely as a profession due to advances in scientific research and increasingly rigorous educational standards. Nonetheless, as an RMT whose practice focuses on pre- and postnatal care, I am often surprised to find that my patients, fellow health care practitioners and the general public continue to be plagued by myths and misconceptions surrounding our work, in particular pertaining to massage therapy during pregnancy. Here are some of the most common myths I regularly de-bunk:

 

Myth #1 – Massage during the first trimester can lead to a miscarriage

 

The first twelve weeks of any pregnancy is a delicate time during which the pregnant person’s body determines whether the fetus is viable. It is a critical period of development, and due to the extreme prevalence of miscarriage from natural causes (1) many people avoid advertising their pregnancy or getting a massage until the second trimester. There is no research to support this precaution. Consider that the fetus is extremely well protected in its parent’s body, which is made up of layers upon layers of muscle, fascia and adipose tissue, not to mention the growing amniotic sac and fluid, all of which provide a buffer from movements and pressure. To further put it into perspective, the fetus itself ranges between the size of a poppy seed and a lime during the first trimester. (2)  As such, any regular day-to-day activities are more likely to cause strain than an RMT who is treating safely and within scope, based on pregnancy-specific modifications. It would appear that many massage therapists are nervous about providing massage during the early stages of pregnancy due to the fear that their actions could be associated with a subsequent miscarriage, and that they could be the subject of litigation as a result. If you fall into that category, you may want to think about getting more training or referring your patient to someone with postgraduate training in perinatal massage, who will be able to understand the pregnant person’s fears and misgivings and deal with them with tact and sensitivity.

 

Myth #2 – Getting a massage in the third trimester can induce labour

In the third trimester, the body is preparing for birth. The pregnant person may be having Braxton-Hicks contractions, her hormone levels are in flux as progesterone levels decrease to allow the uterus to contract and relaxin softens her ligaments so her pelvis can open and the baby can move down into the lower part of the pelvis. Many childbearing parents experience increased physical discomfort due to the growing size of the baby and associated postural and gait changes, as well as increasing excitement (or trepidation) about meeting the baby. As a result, many are eager to speed up the birthing process and seek massage therapy to “get things going”. (Un)fortunately, massage therapy cannot induce labour (and even if it could, it is outside our scope). Babies come when they and their parent are both ready, and not a moment before unless they are medically induced. What massage can do is relieve tension, both physical tension that may be causing an imbalance in the pelvic region and preventing it from opening evenly, and emotional tension that may be interfering with the flow of the “love” hormone, oxytocin, nature’s own uterine contractor and prostaglandin stimulator. As internal treatments fall beyond our scope as RMTs, having a qualified pelvic floor-focused physiotherapist handy for referrals is always a good idea. And to ensure the utmost in relaxation during this challenging time, the RMT must take into account how belly and baby are positioned to avoid increased strain or intensified Braxton-Hicks contractions.

 

Myth #3 – Massaging feet or ankles can induce labour

 

This myth appears to stem from the presence of acupressure and acupuncture points on the feet and ankles said to stimulate the uterus, and sadly it does a real disservice to pregnant people. One of the most common complaints of pregnancy is water retention, specifically swollen feet and legs. As massage therapists, we have an excellent skill set to help with this type of edema. Indeed, one small study found that daily foot massage during late pregnancy significantly reduced edema levels after five days. (Ayden Çoban RN PhD, 2010) But what about the acupressure points? All controversy about the efficacy of acupressure and acupuncture for inducing labour aside (Shahnaz Torkzahrani, 2017), it is clear that the techniques used to manually stimulate these points —namely firm pressure with a finger in a circular or up-and-down movement for several minutes at a time (4)—bear no relation to  lymphatic drainage protocol. So go ahead and give a pregnant person a foot massage and give them some relief from that swelling.

 

Myth #4 – A pregnant person cannot receive massage because she cannot lie on her belly

 

Just about every popular pregnancy magazine, website and blog, as well as many health care practitioners, recommend lying on the left side as the best position for sleeping during pregnancy. Notwithstanding the fact that side-lying is an ideal position to treat a pregnant person in the late second and third trimester, studies show that pregnant people can assume a variety of positions, apparently without lasting ill effects on themselves or their fetus (9). There are many pillowing techniques and supports which support ideal alignment and reduce ligament strain whether the patient is side-lying, prone or semi-reclining. The most important thing to avoid is having a pregnant person lying supine for extended periods as the weight of the uterus and baby on the inferior vena cava can temporarily cause low blood pressure. This is relieved by a position change, whether by having the patient switch to a semi-reclining position and/or placing a wedge under her right hip. As for lying prone, while insufficient supports can place uterine ligaments in an overstretched position and it could be increasingly uncomfortable as the baby grows, there is no specific research indicating that it’s unsafe. That being said, it’s of the utmost importance to make sure that you are treating your pregnant patient prone because it is the position that she feels most comfortable in, not because it is the one you are most accustomed to. Many patients will tolerate an uncomfortable position rather than question their massage therapist, so be sure to emphasize and ensure that her best interests are paramount.

 

Myth #5 – Massaging a pregnant belly can cause a miscarriage

 

Gentle massage of the abdomen is safe for both parent and baby with proper draping and appropriate consent. It’s important to work within the patient’s comfort level and to never use more pressure than she would use herself. Most massage techniques that would be used directly on a pregnant belly would be those similar to effleurage and rocking, to provide a soothing treatment. The intent is not to massage the baby but rather the tightly stretched muscles and skin. One area which is often clinically indicated is the diaphragm. Techniques to release the diaphragm can allow the patient’s ribcage to expand further, permitting deeper breathing and sometimes providing relief from heartburn.

 

Myth #6 – Massage therapists can reposition a breech baby before or during labour

 

Turning a breech baby does NOT fall within the scope of practice for an RMT, though we can encourage optimal fetal positioning through exercise and positional recommendations during pregnancy. Interestingly, labour support DOES fall within our scope. While most who pursue this line of work take additional training before attending any births, it is safe to say that by virtue of the kind of work we do those who are interested in comforting and soothing a birthing person are already equipped with many of the essential skills for being helpful in a birth setting. Upon graduation, RMTs have extensive anatomical knowledge and the ability to assess what kinds of techniques could be used to relieve labour pain. An RMT has the strength and endurance to apply hands-on techniques repeatedly over the course of several hours. We have the professionalism and educational background to be able to relate to other health care providers in home, hospital and birth centre settings. RMTs help reduce the anxiety of their labouring patient through touch and emotional support, even if an epidural is sought.

 

To summarize – no, massage therapy does not cause miscarriage or induce labour, whether in the first or any other trimester – yes, massage can be enjoyed in a variety of positions during pregnancy – and, yes, while an RMT cannot reposition a breech baby, she can be of immense benefit to a birthing person during labour. So don’t be afraid to tell your colleagues, other health care professionals and pregnant patients that pregnancy-related leg and back aches and pains, nausea (Annelie Ågren RNM, 2006), depression and anxiety (Field, 2010) can all be relieved by massage therapy performed by a well-trained and sensitive therapist – pregnant people will thank you for it.

References

 

(1). Retrieved from https://www.healthline.com/health/pregnancy/miscarriage-rates-by-week#1

(2). Retrieved from https://www.babycenter.com/slideshow-baby-size

(4). Retrieved from https://exploreim.ucla.edu/self-care/acupressure-and-common-acupressure-points/

(9). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28658431

Annelie Ågren RNM, M. M. (2006, May 24). Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1471-6712.2006.00394.x/abstract;jsessionid=3A9B8F18626FF6D473CE47801D322403.f04t01

Ayden Çoban RN PhD, A. Ş. (2010, September 20). Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1440-172X.2010.01869.x/abstract

Field, T. (2010). Pregnancy and labor massage therapy. In Expert Review of Obstetrics and Gynecology (pp. 5, 177-181). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870995/

Shahnaz Torkzahrani, F. M. (2017, February). The effect of acupressure on the initiation of labor: A randomized controlled trial. Women and birth: Journal of the Australian College of Midwives , 46-50. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27444642