Pregnancy is a wonderful thing…

I say this as a man, with limited (okay… nonexistent) first-hand knowledge of what it feels like. That said, I will add that I was actively supportive through my wife’s pregnancy, prenatal care, and the birth of our child. What I relate in this writing comes from a place of abject humility and respect for what women undergo during their transition to motherhood.

My most satisfying experience as a maternity massage specialist was having my wife as a client. She’s not prone to outward displays of discomfort, so when she would wince with pain, or walk around holding her back, neck, or shoulder, I’d know that something really hurt. I’d see these signs and realize that there was something I could do in my role as support staff. This second-hand knowledge doesn’t make me an expert on what mothers-to-be experience, but it gives me a clue as to how I can help.

The gestational months bring many changes to a woman’s body, and volumes have been written to describe them. In the interest of brevity, I’ll only attempt to hit the highlights that apply to maternity massage.

Structure

The structure of a pre- and perinatal woman’s body is in a constantly changing state. The increased release of the hormone relaxin early in pregnancy causes the body to … well … relax. Not in the beneficial sense that you would relax into a hot bath at the end of a long day, however. Among other functions, this hormone relaxes the body’s joints, to help the pelvis expand to accommodate an enlarging uterus, and facilitate the baby’s passage through the birth canal. The downside to this loosening of the joints is that it weakens the entire skeletal framework that holds the body up (imagine how rickety the Eiffel Tower would be if all of the rivets and bolts holding it together were loosened).

Due mainly to a rapidly growing fetus, the distribution of weight of the pregnant woman is ever changing as well. As the abdomen expands forward, the center of gravity moves with it. The breasts may enlarge, further shifting the weight bias forward. At the onset of my father-to-be status, I became much more aware of the number of pregnant women around me, and their differing range of postures. To the lay person, the protruding belly marks one as pregnant, but the trained eye can pick out the stance of a woman coping with deep structural issues: hips tilted forward, shoulders rounded; back, neck, and shoulder muscles working to maintain equilibrium. To top it all off, the body is trying to add stores of fat to cope with the baby’s impending nutritional and caloric needs. This weight gain further adds to the load the musculoskeletal frame must contend with.

The third ingredient in this perfect storm of structural stress is the role of the muscles themselves. The rectus abdominis (the abdominal muscles associated with the “six-pack abs”), which up until the third trimester have been stretching to accommodate a growing fetus, split and separate down the middle (diastasis recti). I had one client liken this phenomenon to the parting of the Red Sea. These abdominal muscles normally play a vital role in supporting the trunk, balancing the efforts of those in the lower back. With their incapacitation, it is up to the muscles surrounding the lumbar spine to provide all the impetus for posture and locomotion.

A trained prenatal specialist can make a big difference to these muscles that are coping with their increased burdens. While soothing the soreness, massage also helps the body to flush the lactic acid and other by-products of exertion from tired muscle tissue. Chronically knotted muscle fibers, when unraveled and returned to normal function, are better able to adapt to the new demands imposed on them. Recently, I received an urgent call from a regular client in her 38th week, who had decided to clean out her basement on a whim. Needless to say, she was sore (to near incapacitation) from lifting, squatting, hauling, and doing who-knows-whatever-else. After an hour’s massage session (and some chiding about inappropriate late-term activities), she was feeling like a new woman, and ready for the countdown to birth.

Emotions and Hormones

Having a baby is an emotional roller coaster. As expectant parents, my wife and I were thrown from side to side regarding everything from affording college tuition to choosing a brand of diaper. Blood tests and ultrasounds for disorders I’d never heard of added to our list of worries. From the monumental to the mundane, it seemed that each day brought a new issue to stress over. I won’t bore you with details… if you’ve been there, you know them all. Though not exclusive to pregnancy, stress hormones brought about by these emotional issues can elevate blood pressure, and increase heart and respiratory rates. Not to mention making you feel like you’re frazzled and at wits’ end.

Adding insult to injury, it seems that many of the counter-measures for stress (vigorous exercise, hot baths, a glass of wine with dinner, etc.) begin to creep onto the list of no-no’s as pregnancy progresses. Even sleep, nature’s built-in antidote for mounting tension, becomes fragmented and less fulfilling as the body changes and favorite positions become uncomfortable or taboo.

During pregnancy, many changes occur due to hormonal activities that are rarely seen otherwise. Some crucial ones (as far as massage is concerned) increase the body’s blood volume (by 30%- 50%) and clotting capacity. These help keep up with the extra demands for oxygen, nutrition, and growth of the uterus and fetus, and to help protect the mother from hemorrhaging during childbirth. Overall fluid levels increase as well, leading to swollen hands, calves, ankles, and feet in the latter months of pregnancy.

Therapeutic massage can make a big difference with these discomforts. The sense of relaxation and wellness that follows a good session leaves lasting effects on the body. The nervous system, raw from stressors and fitful sleep, begins to normalize again. The worries of the expectant parent are still present, but less stress allows for a renewed ability to cope with them. In addition, treating yourself to a relaxing hour for the health of you and your baby can transform a pressure-cooker day into a day at the beach.

Regular massage also has a positive effect on the body’s fluid distribution. When excess fluid pools in the lower legs and ankles, causing pain and discomfort, massage strokes can help draw it back up. On many an occasion, my wife would request just such a treatment to help her body regain some sense of normalcy, and provide relief to her aching swollen feet.

The Difference Between a Maternity and a Regular Massage

I’ve talked about a few ways that massage therapy can help the expectant mother. So why choose a prenatal specialist? The short answer is that therapists trained in maternity massage understand which techniques and positions are helpful and recommended.

For instance, there are regions of the leg that should be avoided and those that are not only safe, but respond well to massage. Awareness of the differences between these specific zones, and how best to safely and effectively work with them, are two principal elements of specialized prenatal training. A trained practitioner is schooled in how to massage the lower extremities without risk.

If you’ve ever had a regular massage, you’re probably familiar with lying face down as your back is worked on (prone positioning). It’s a staple of my profession for good reason: it’s effective, and it feels marvelous to the client. At about week fourteen, however, discomfort caused by the increasing size and forward migration of the fetus requires a different approach to positioning the client. This is where the increased safety and effectiveness of the side-lying arrangement comes in. Through use of cushions to stabilize the knees, pelvis, and shoulders, the therapist is able to apply judicious pressure to the muscles of the neck, back, and hips. This position, it turns out, ends up being so comfortable, I’ve had several clients ask for ways they could adapt it to home use for sleeping! With proper training, a therapist can give a thorough and satisfying massage during maternity.

Final Thoughts

Maternity massage can be a wonderful addition to your regular prenatal care. Remember to keep your doctor or midwife up to date on any new health regimens you begin during pregnancy, massage included. Clinical studies at the University of Miami’s Touch Research Institute are yielding some remarkable findings. Their research has shown “decreased anxiety and stress hormones (norepinephrine) during pregnancy and fewer obstetric and postnatal complications following pregnancy massage.”¹ The positive effects are long-ranging, and begin as soon as you recline on the table.

“So how much massage should I get while I’m pregnant,” you ask? My experience has been that during the first trimester, once every three to four weeks is a good start. Increasing the frequency to once every two weeks as your pregnancy progresses will bring cumulative benefits, with reduced aches and pains, improved mood, and better sleep. If you’re from the “more is better” camp, opt for more frequent appointments over lengthy ones. Although it may be tempting to go for marathon ninety-minute sessions, an hour on the table is not only plenty, it’s preferred.

My wife gave birth to a wonderful little baby boy. I’ll not claim that my hands-on skills were responsible for her feat, or that what I brought to the table made her pregnancy a walk in the park. But it was a help… and she recommends maternity massage to all she can tell.

- Erik Taylor LMT, NCTMB

References:
¹ Touch Research Institute, University of Miami; Field, T., Hernandez-Reif, M., Hart, S., Theakston, H., Schanberg, S., Kuhn, C. & Burman, I. (1999). Pregnant women benefit from massage therapy. Journal of Psychosomatic Obstetrics & Gynecology, 20, 31-38.