Massage therapy has long been recognized for its therapeutic benefits, including stress reduction, muscle tension relief, and overall health improvement. During pregnancy, massage can be particularly beneficial, but it's essential to understand the specific considerations and potential risks involved. This article will discuss the benefits and risks of pregnancy massage, including expert opinions and research findings.
Introduction
Pregnancy brings about significant physiological and emotional changes, often leading to discomforts such as back pain, swelling, and anxiety. Massage therapy offers a non-invasive approach to alleviate these issues. However, concerns about the safety of massage during pregnancy are common among healthcare professionals and expecting mothers. This article aims to provide a comprehensive overview of the effects, side effects, and contraindications of relaxation massage during pregnancy, based on current research and expert recommendations.
Benefits of Pregnancy Massage
Reduced Stress and Improved Mental Health
Massage treatments are a potent tool to alleviate stress, anxiety, pain and depression in various patient groups. Studies indicate that massage therapy performed during pregnancy can reduce anxiety, decrease symptoms of depression, relieve muscle aches and joint pains, and improve labor outcomes and newborn health. Recent systematic reviews with meta-analyses have investigated the effects of massage and other complementary therapies on pregnant women’s anxiety and depression. The authors found promising effects.
Psychosocial stress and depression are among the major risk factors during pregnancy, which may negatively impact the mother’s health as well as the development and growth of the fetus. Untreated or insufficiently treated prenatal depression is linked to complications during pregnancy, such as preeclampsia, early labor, and more frequent caesarian deliveries. Aside from that, newborns delivered by mothers suffering from prenatal depression are more often in need of intensive care: children born by depressed mothers have a lower birth weight and a smaller head circumference than children delivered by healthy mothers. In addition, dyspnea and/or feeding disorders are more prevalent. Depression during pregnancy can also lead to growth retardation and can have a negative impact on cognitive, motoric and emotional developments during infancy and childhood. Furthermore, prenatal depression is one of the leading risk factors for postpartum depression which, in turn, bears significant developmental risks during infancy and early childhood.
Hormone regulation is significantly altered, leading to mood regulation and improved cardiovascular health, when massage therapy was introduced to women’s prenatal care. In women who received bi-weekly massages for only five weeks, hormones such as norepinephrine and cortisol (“stress hormones”) were reduced and dopamine and serotonin levels were increased (low levels of these hormones are associated with depression). These changes in hormone levels also led to fewer complications during birth and fewer instances of newborn complications, such as low birth weight. Recent research confirms the positive effect of massage on the cortisol and noradrenaline concentrations of depressed pregnant women. In addition, the concentrations of dopamine and serotonin have been found to increase significantly after massages, a fact that underpins the reports of decreased anxiety and depression levels.
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Pain Relief
Massage therapy addresses different needs through varying techniques, one of which is called Swedish Massage, which aims to relax muscle tension and improve lymphatic and blood circulation through mild pressure applied to the muscle groups of the body. Swedish Massage is the recommended prenatal massage method during pregnancy because it addresses many common discomforts associated with the skeletal and circulatory changes brought on by hormone shifts during pregnancy. Massage therapy has been shown to be effective in reducing depression, anxiety and back pain during pregnancy. The most common request from pregnant guests involves massages that are focused on the lower back, hips, neck and feet.
Several studies have indicated that massage during pregnancy can alleviate physical discomforts:
- Reduced Back and Joint Pain: Massage helps alleviate the strain on the back and joints caused by the changes in posture and weight distribution during pregnancy.
- Improved Circulation: Edema, or swelling of the joints during pregnancy, is often caused by reduced circulation and increased pressure on the major blood vessels by the heavy uterus. Massage helps to stimulate soft tissues to reduce collection of fluids in swollen joints, which also improves the removal of tissue waste, carried by the body’s lymph system.
- Sciatic Nerve Pain Relief: Sciatic nerve pain is experienced by many women in late pregnancy as the uterus rests on muscles of the pelvic floor and lower back. The pressure of the uterus spreads tension to the muscles of the upper and lower leg, causing them to swell and put pressure on nearby nerves. Massage therapy addresses the inflamed nerves by helping to release the tension on nearby muscles. Many women have experienced significant reduction in sciatic nerve pain during pregnancy through regular massage.
- Muscle Tension and Headaches: Massage can reduce muscle tension and headaches, common discomforts during pregnancy.
Improved Labor Outcomes and Newborn Health
Studies indicate that massage therapy performed during pregnancy can improve labor outcomes and newborn health. The evidence points strongly to maternal and newborn health benefits when therapeutic massage is incorporated into regular prenatal care. One study focused on massage effects on pregnancy-related non-clinical anxiety. They found significant improvements in women receiving massage treatments and women performing guided imagery exercises, while anxiety scores in the standard care control group increased.
Massage treatments performed by the partner may have additional positive impact on the quality of the relationship. As research shows, partner massages have the potential to both alleviate existing stress and to prevent psychosocial stress by reducing the number of relationship conflicts.
Other Potential Benefits
Other potential benefits of prenatal massage include:
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- Improved oxygenation of soft tissues and muscles
- Better sleep
Precautions and Risks
As with any therapeutic approach to pregnancy wellness, women should discuss massage with their prenatal care provider. The best way to address the risks of prenatal massage is to be informed and to work together with knowledgeable professionals.
Contraindications
Women with the following conditions should speak with a health care provider prior to receiving a massage:
- High risk pregnancy
- Pregnancy induced hypertension (PIH)
- Preeclampsia
- Previous pre-term labor
- Experiencing severe swelling, high blood pressure, or sudden, severe headaches
- Recently gave birth
Body Position
Many professionals consider the best position for a pregnant woman during massage is side-lying. Tables that provide a hole in which the uterus can fit may not be reliable and can still apply pressure to the abdomen, or allow the abdomen to dangle, causing uncomfortable stretching of the uterine ligaments. Consult your massage therapist before your first appointment to verify what position they place their clients in during the massage. Lying on your back once you’re in your second trimester can also be unsafe, as the weight of your growing belly can compress an important blood vessel in your back and interfere with blood flow to baby.
Sensitive Pressure Points
Trained prenatal massage therapists are aware of pressure points on the ankles and wrists that can gently stimulate pelvic muscles, including the uterus. Certified prenatal massage therapists are trained to avoid very specific and intentional pressure to these areas during pregnancy. Any woman who has experienced pre-term contractions or consistent Braxton-Hicks contractions should alert her therapist to that fact so that pressure points can be avoided completely.
Deep Vein Thrombosis (DVT)
One study highlighted that pregnant women are more likely to have unidentified deep vein thrombosis. It’s possible that a vigorous leg massage could dislodge a blood clot, potentially leading to an embolism. For this reason, deep tissue massage and strong pressure on the legs should be avoided. Instead, very light, slow strokes on the legs should be used. Types of massage to avoid on the legs include deep-tissue massage, deep acupressure, shiatsu, cross-fiber friction, and percussive tapping.
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First Trimester
Some facilities will refuse to offer massage to a woman who is still in her first trimester. Your physician can advise you of any risks. Some massage therapists won't give pregnancy massages during the first trimester. The reason is the potential for miscarriage. Some pregnancy massage experts argue that pregnancy massage doesn't, in itself, cause miscarriage, but no research has been done to show a link between a massage and a miscarriage. Because many miscarriages happen in the first trimester, some massage therapists and doctors counsel against first-trimester massage simply to avoid any potential liability issues should a miscarriage occur.
Essential Oils
Offices that specialize in prenatal massage usually have women lie on their sides while propped up with pillows or use tables with cut-outs where their bellies can rest. It’s also important that the therapist is aware of what essential oils or lotions are OK to use in pregnancy, as many have analgesic and calming properties. Not all are considered safe.
Finding a Qualified Therapist
It is important to seek care from a certified prenatal massage therapist. Certified therapists have received training beyond the national standards for massage therapists and know how to address specific pregnancy and massage needs and sensitive areas of the body. Not all states have laws requiring a set minimum training for a massage therapist, regardless of whether or not the therapist's client is pregnant. Also, like many forms of complementary medicine, massage therapy during pregnancy hasn't been rigorously studied with high-quality clinical research methods.
Look for a massage therapist through one of the national associations that trains and certifies massage therapists. For example, you could contact the American Massage Therapy Association. Before your first appointment, ask about the therapist's specific training and experience in pregnancy massage.
How to Massage a Pregnant Woman at Home
You may be tempted to hire a live-in masseuse for the duration of your pregnancy, but turning to your partner or a vibrating massager may be the next best thing.
To get set up, make sure you’re comfortable. Tucking supportive cushions under you helps keep the body in alignment when you’re lying on your side. Place a pillow between your knees for added support. Next, consider if you’d like to use a lotion or massage oil. While essential oils are by no means necessary for a successful at-home prenatal massage, aromatherapy can enhance the experience. Just give the oils a sniff before using to make sure your heightened senses aren’t offended, and steer clear of certain essential oils (like fennel and sage) that aren’t recommended during pregnancy.
Ready to try a prenatal massage at home? Your partner can still massage your feet, as long as they’re careful to avoid the ankle area. Instead of kneading your leg muscles (especially if you have varicose veins), have your partner rotate your thigh muscles (quads and hamstrings) around your femur-first clockwise, then counter clockwise-as you stand leaning over a chair or countertop. Lyon recommends a standing “double hip squeeze,” which can be a great massage during pregnancy and even labor. Lean forward onto a table or countertop with your forearms supporting the upper body. Ask your partner to stand behind you and squeeze your hips (the fleshy sides of glutes) inward. They should hold, but not massage, your hips for 10 seconds and then release. Repeat several times. You can do this lying on your side or while straddling a chair. Since your neck and shoulders carry a lot of tension, ask your partner to ease any knots with long, moderate-pressure movement down your trapezius muscles-the back muscles that extend down your neck, out to your shoulders and into your upper back, forming a trapezoid shape.
Precautions for At-Home Massage
During your massage, you should be lying on your side - not your back or stomach - or sitting upright or in a semi-reclining position. For starters, lying on your stomach is uncomfortable. In addition, lying on your back after 20 weeks could put pressure on blood vessels, including your aorta and inferior vena cava, which can restrict blood flow. This in turn can cause your blood pressure to drop and decrease blood flow to your uterus.
You may also want to be careful on certain parts of your body:
- Your belly. You’ll probably want to avoid having your growing belly and the area around it massaged because this could hurt you or the baby. It’s OK to gently rub some stretch mark cream into your belly, though.
- Your legs. It’s fine to rub or stroke your legs gently, but make sure that your partner doesn’t use too strong of deep tissue pressure. Because your blood volume increases when you’re pregnant, blood flow in your legs can slow down, making you prone to clots. So deep tissue massage on your legs could dislodge a clot.
- Pressure points. As we hinted at above, in reflexology, you have pressure points in some regions of your body, like your wrist, ankle, or between your fingers. Some people say that massaging these areas may cause contractions, but there’s currently no evidence to support the claims.
Research and Studies
Several studies have highlighted the benefits of massage during pregnancy:
- One study at the University of Miami School of Medicine suggests that massage therapy might have multiple positive effects, including lowered anxiety, decreased back and leg pain, and improved sleep.
- In another study of pregnancy massage in depressed women, researchers found increased levels of the "feel-good" hormones serotonin and dopamine and decreased levels of cortisol, an indicator of stress, leading to an overall improvement in mood.
- A study published in Expert Review of Obstetrics and Gynecology found massage therapy effective in reducing depression, anxiety, and back pain during pregnancy.
- Research from 2011 has suggested that massage during pregnancy may help decrease depression and anxiety, and leg and back pain.
- Another recent study showed that massage could help relieve fluid buildup or swelling that comes with pregnancy and a 2017 study found that it might just help you relax and lower your stress levels.