Pregnancy brings about numerous physical and emotional changes, often accompanied by discomfort and stress. Massage therapy has emerged as a popular complementary therapy for pregnant women, offering potential relief from these challenges. This article explores the benefits and risks of prenatal massage, providing evidence-based information and practical guidelines for expecting mothers and healthcare professionals.
Introduction to Prenatal Massage
Massage treatments are a potent tool to alleviate stress, anxiety, pain and depression in various patient groups. Prenatal massage is a self-care and complementary medicine practice that can help relieve the emotional and physical discomforts of pregnancy. It is a specialized form of massage therapy tailored to address the unique needs of pregnant women, taking into account the anatomical and hormonal changes that occur during this period. Healthcare professionals and expecting mothers frequently voice concerns that massages during pregnancy might be unsafe or cause complications. This review outlines current results on effects, side effects and contraindications of relaxation massage during pregnancy.
Benefits of Prenatal Massage
Prenatal massage offers a wide range of potential benefits for both the mother and the developing fetus. These benefits can be broadly categorized into physical and psychological effects.
Physical Benefits
- Reduced Pain and Discomfort: One of the most common reasons pregnant women seek massage therapy is to alleviate pain, especially back and leg pain. As baby grows, your body has to account for the changes, and that can cause some discomfort. Massage helps to stimulate soft tissues to reduce the collection of fluids in swollen joints. Sciatic nerve pain is experienced by many women in late pregnancy as the uterus rests on muscles of the pelvic floor and lower back. Massage therapy addresses the inflamed nerves by helping to release the tension in nearby muscles. Recent meta-analyses have shown that manual therapy techniques (craniosacral therapy, osteopathic manipulative treatment, chiropractic) are effective treatment tools for pregnancy-related low back pain and pelvic girdle pain when compared to standard care control groups. In line with the above reported positive effects on pregnancy-related pain through regular relaxation massage, these results indicate that intense manual techniques may not be necessary to reduce headaches, back pain and muscle cramps during pregnancy. Whether you’re pregnant or not, getting a massage may decrease stress hormones and spur production of oxytocin.
- 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 the collection of fluids in swollen joints.
- Enhanced Immune Response: Staying healthy is all the more important when you’re expecting, but pregnancy naturally lowers your immune defenses. Massage treatments performed by the partner may have additional positive impact on the quality of the relationship.
- Improved Labor Outcomes: In a study of labor pain, women who received massage therapy experienced significantly less pain, and their labors were on average 3 h shorter with less need for medication. Massage therapy during the first 15 min of every hour of labor decreased anxiety and pain and the need for pain medication.
Psychological Benefits
- Reduced Stress, Anxiety, and Depression: Massage treatments are a potent tool to alleviate stress, anxiety, pain and depression in various patient groups. 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. Several studies have shown that prenatal massage can significantly reduce stress, anxiety, and depression levels in pregnant women. In one study, pregnant women who received group psychotherapy plus massage treatments attended more psychotherapy sessions over the course of several weeks than women who received only psychotherapy. The experimental group, which received both massage treatments and psychotherapy, demonstrated a larger decline in depression, anxiety and cortisol levels than the control group treated solely with psychotherapy. Furthermore, two studies compared the Hamilton Depression Rating Scale scores (HDRS) of pregnant women who received either 8 weeks of acupuncture or 8 weeks of massage therapy. They found significant reductions of HDRS in both groups that were similar to treatments with antidepressants or cognitive therapy (reduction of HDRS approximately from 21 to 14) [36,37]. Remission rates were 34.8% in the acupuncture group and 31.2% in the massage group. Moreover, only 2% of women in the massage group reported side effects (tiredness after treatment), while almost half of participants in the acupuncture group experienced mild or transient side effects (e.g., nausea, headache or sleep disturbance after treatment). In line with these results, a current meta-analysis of four RCT (all four conducted by Field et al.) revealed a moderate effect of massage therapy on pregnant women’s depressive symptoms [26]. Moderate pressure and touch stimulate the skin, which in turn activates nerve receptors to calm the mind. The vagus nerve, in particular, serves to regulate internal organ function, including heart rate and respiratory rate.
- Increased Serotonin and Dopamine Levels: Studies have shown that massage therapy can increase serotonin and dopamine levels, which are neurotransmitters associated with feelings of well-being and pleasure. 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.
- Improved Mood: 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.
Fetal Benefits
- Higher Fetal Birth Weight and Reduced Risk of Preterm Delivery: Regular relaxation massages during pregnancy may have positive effects on the development and growth of the fetus. So far, these effects have been primarily investigated in depressed pregnant women. However, similar effects can be expected in association with other psychosocial stress factors. The four included studies that investigated fetal outcome showed that depressed women who received regular relaxation massages during pregnancy had lower incidence of premature births and delivered children with higher birth weight than women in the control groups
- Reduced Fetal Cortisol Levels: Furthermore, the newborns of depressed mothers who received massages had lower cortisol levels and scored better on behavioral and neurological tests.
- Enhanced Neonatal Development: The newborns of the massaged mothers also had lower cortisol levels than the newborns of the control mothers, and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales.
Potential Risks and Contraindications
While prenatal massage is generally considered safe, there are certain risks and contraindications to be aware of.
- First Trimester: The first trimester carries an increased risk of miscarriage, and some therapists are concerned that the increased blood flow during a massage might be harmful. Limiting or avoiding massage during early pregnancy when miscarriage rates are highest is considered the safest route.
- High-Risk Pregnancies and Medical Conditions: Massage therapy engages the circulatory system, which can alter blood flow in the body and potentially affect certain health conditions. If you have any of the following issues, talk to your doctor before getting a prenatal massage at any point in your pregnancy: High blood pressure that isn’t controlled by medication, High-risk pregnancy concerns, such congenital heart disease or preeclampsia, Recent injury or surgery, Recent organ transplant.
- Deep Vein Thrombosis (DVT): In the later stages of pregnancy, the levels of anticoagulants is heightened to prevent hemorrhaging during labor, therefore if you use too much pressure on the legs this could dislodge any blood clots the body has created. 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.
- Pressure Points: There are pressure points that correlate with the reproductive organs. It’s true there are certain pressure points that may stimulate the uterus and cause contractions, but an average prenatal massage from a well-trained therapist isn’t going to catapult you into labor.
Guidelines for a Safe and Effective Prenatal Massage
To ensure a safe and effective prenatal massage, consider the following guidelines:
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- Consult with Your Healthcare Provider: Always check with your pregnancy provider before getting a prenatal massage, particularly if you’re experiencing a high-risk pregnancy.
- Seek a Certified Prenatal Massage Therapist: It is important to seek care from a certified prenatal massage therapist. They are aware of how to position you safely and prevent strain on the uterine ligaments.
- Communicate with Your Therapist: Be sure to communicate openly with your therapist about any concerns or discomfort you may be experiencing.
- Assume a Safe Position: Starting in the second trimester (and beyond), lying on your side-possibly propped up by pillows-is ideal during a prenatal massage, says Meleen Chuang, MD, an ob-gyn and clinical associate professor at the Family Health Centers at NYU Langone. Lying on your stomach is no longer a comfortable or safe option, and massage tables that feature a belly cutout can still apply pressure to your abdomen, notes Chuang. Plus, having your belly dangle can also cause the uterine ligaments to stretch uncomfortably. 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.
- Avoid Extremes: Most massage therapists won’t offer hot stone massage for their pregnant clients, as raising your core temperature isn’t recommended in pregnancy. Many also decline to perform deep tissue massage, since too much pressure-especially near veins in the legs-can potentially dislodge a blood clot, which expectant moms are at higher risk of developing.
- Stay Hydrated: It’s important to hydrate before your appointment. Pregnant women require additional fluid intake anyway, so drink a few extra glasses of water before and after your appointment.
- Be Mindful of Essential Oils: 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.
Techniques Used in Prenatal Massage
- Swedish Massage: Swedish Massage aims to relax muscle tension and improve lymphatic and blood circulation through mild pressure applied to the muscle groups of the body. Studies done in the past 10 years have shown that hormone levels associated with relaxation and stress are significantly altered when massage therapy is introduced to women’s prenatal care. These changes in hormone levels also led to fewer complications during birth and fewer instances of newborn complications, such as low birth weight.
- Moderate Pressure: In order for the massage to be effective, moderate pressure should be applied, which the women perceive as pleasant and non-painful.
When to Get a Prenatal Massage
Hill says most pregnancy providers usually recommend waiting until the beginning of the second trimester (12 weeks pregnant and beyond) to get a prenatal massage. Once your pregnancy is into the second trimester, the more massages the merrier. Hill recommends getting a massage once every two weeks for maximum benefit. As you hit the end of the third trimester and the discomforts add up, you can get a massage up to once a week.
At-Home Prenatal Massage Techniques
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.
- Thigh Rotations: 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.
- Double Hip Squeeze: 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.
- Neck and Shoulder Massage: 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.
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