Prenatal massage

Author: Evgenia Radionova, director and teacher of the International School of Massage (Ukraine, Kiev)

Pregnancy is a special time in a woman’s life. This period is associated not only with the joy of expecting a child, but also with a number of possible problems both on the physical and psycho-emotional levels. All of them, of course, are a consequence of hormonal and physical changes in the body of the expectant mother and occur even during the normal course of pregnancy (for example, pain in the back, neck, lumbosacral region, sacroiliac joints, lower extremities, cramps of the calf muscles; general fatigue, dizziness, insomnia, headache; psycho-emotional and physical stress). One of the means to solve these problems and prepare for childbirth is massage.

Special approach

First of all, it should be noted that traditional massage techniques are not suitable for pregnant women; in this case, a special individual approach is required, and the massage therapist must have the necessary knowledge and qualifications. It is also important that the patient, before undergoing a massage course, receives a consultation with her gynecologist.

There are a number of contraindications to the use of massage during pregnancy:

• acute inflammation of blood vessels and lymph nodes, venous thrombosis and thrombophlebitis, pronounced varicose veins;
• gestational diabetes;
• heat;
• vomit;
• preeclampsia or eclampsia;
• intestinal disorder;
• threat of miscarriage;
• placental dysfunctions;
• infectious diseases;
• diseases of hair, nails, skin;
• tumors, etc.

The main tasks when performing a massage for pregnant women are relaxation, pain relief, activation of blood circulation and lymph flow, elimination of congestion in the pelvis and lower extremities; strengthening muscles, relieving stress on joints; improving general metabolism, preparing for childbirth. By the way, studies conducted by the University of Miami (USA) for 10 years showed that when using massage twice a week for five weeks, the level of cortisol (“stress hormone”) and norepinephrine in a woman’s body significantly decreases, at the same time over time, the levels of dopamine and serotonin increase. These changes ultimately lead to fewer complications during birth and fewer complications in newborns, such as low birth weight.

Comfortable position

During normal pregnancy, the massage can last from 10 to 60 minutes. The optimal number of general massage procedures is 1-2 per week.

Particular attention should be paid to the position of the patient’s body during the massage - it should be as comfortable as possible and ensure complete relaxation.

There are three options for the position of a pregnant woman when performing a massage.

Lying down, lying on your side. During the first trimester, women can lie in the “prone” position. However, many experts do not recommend performing massage in the first trimester at all, which is associated with a high risk of pregnancy failure. If there is no danger of miscarriage, then when performing a massage in the “on the stomach” position, you can place small pads under the subclavian areas to eliminate possible pain in the mammary glands.

During the second and third trimesters, the client can sit on a specially equipped couch with openings for the chest and abdomen. But if the office does not have such equipment, then she can lie in the “sideways” position. (It should also be noted that experts disagree about the safety of special maternity couches. Such couches often do not provide complete comfort for the patient. Very often, the stomach does not fit into the opening, which puts additional pressure on it, or the stomach collapses, which creates additional stress for uterus).

The “side” position is the most commonly used and most comfortable. The leg that is on top is bent at the knee and hip joints. The bottom one is straight. Soft pillows should be placed under the bent knee and under the stomach. In this position, you can massage the neck, back, lower back, buttocks, and also massage the limbs.

It is also worth considering that lying on your back after the 20th week is not recommended.

Sitting. Also comfortable is the “sitting” position, when the client sits astride a chair, her hands are folded on its back, and a pillow can be placed between the back and the client. In this position, you can massage the buttocks area, lower back, back, neck, shoulders, and scalp.

Half sitting. In the “half-sitting” position, the client leans on the half-bent back of the couch, her legs are slightly bent and spread apart. You can put a pillow under them. This position reduces intra-abdominal pressure, especially in the last trimester. It is convenient for performing a massage of the legs, arms, abdomen, and head.

Execution nuances

When performing a massage, it is best to use base oils or a neutral cream to make your hands glide easier. The use of aromatic or essential oils is not recommended due to possible increased individual sensitivity of the patient.

The technique of performing massage in the first trimester (in the absence of contraindications) should be mainly aimed at general strengthening of the body, preparing the body for the second and third trimester.

In the second and third trimesters, massage should have a more specific focus, such as eliminating back pain, reducing swelling of the limbs, etc. For swelling, cramps of the calf muscles and muscles of the inner thighs, the use of massage and static stretches will be effective.

During the entire forty weeks, you can massage reflex points and areas of the hands and feet. But it should be especially emphasized that there are a number of zones and points of acupressure (reflexology) that are absolutely contraindicated for use during pregnancy. Exposure to them can lead to stimulation of the uterus and pelvic muscles and, as a result, miscarriage or premature birth. At the same time, the impact on many “forbidden” reflex points and zones in the first trimester in the later stages and the postpartum period is completely justified. By influencing these points, you can reduce nervous tension, relieve pain, eliminate swelling, and improve the function of the mammary glands in the postpartum period.

Sequence of influences

The massage starts from the back. First, superficial and deep strokes are performed. The technique is the same as in classic general massage. Pressing on the stomach is naturally prohibited.

This is followed by rubbing, the purpose of which is to increase blood circulation and warm up the body.

When kneading the long back muscles, some pain in the muscles is possible. In this case, it is necessary to perform light soothing strokes and move on to softer kneading techniques. It is prohibited to act on the lumbar region in the first trimester. The area of the shoulder blades and the collar area should be worked out more carefully - it is in these areas that, as a rule, there is the greatest muscle tension.

After this, we move on to a foot massage - it is simply indispensable for relieving fatigue and swelling. All movements are performed from the periphery to the center. You should not act on the inner upper surface of the thighs, as well as on the lower third of the inner surface of the lower leg, since many biologically active points that are associated with the uterus and pelvic muscles are concentrated here. At the same time, it is important to work the calf muscle well.

Hand massage is also performed from the periphery to the center, working on each finger, palm, forearm and shoulder.

As for massaging the front surface, it is necessary to use only stroking, and the movements should be very soft, smooth and rhythmic. This is especially true for the abdominal area. By the way, many experts completely exclude and do not recommend any influence on the abdomen by a specialist, leaving this care to future parents.

In the last trimester of pregnancy, as well as in the postpartum period, massage of the mammary glands is possible. To prevent stretch marks in this area on the hips and abdomen, it is recommended to use creams containing vitamin E (in the absence of individual sensitivity to the components of the cream).

Projections on the face

In addition to carrying out the general classical massage scheme, you can also, at the patient’s request, perform a short massage that stimulates active zones and points of the face that have a direct effect on the nervous system. Activation of these points will certainly relieve nervous tension and stabilize the emotional state, promoting greater relaxation. The work is performed using movements with pressure, circular movements or specific movements that directly affect the nervous system. These zones can be divided into two groups: zones and points on the face and zones and points associated with the face.

Zones and points on the face:

• Lips. The main movement is orbicular stretching of the lip area.
• Mastoid protrusion. Circular pressing movements either with the pads of the fingers or the thenar area of the hand.
• Nose, bridge of the nose. Movements in the form of kneading along the bridge of the nose with three fingers, the remaining two fingers of each hand go along the lagrimal line, with a friction movement we go down to the wings of the nose. Such manipulations will help reduce muscle tension, having a sedative effect on the nervous system and imparting relaxation to the facial muscle system, which will have a beneficial effect on the general condition.
• Brows. The eyebrow arch is stretched with orbicular movements affecting the eye area.
• Eyes. You can use small circular movements with gentle pressure. Among other things, this manipulation reduces blood pressure by reducing the frequency of contractions of the heart muscle.
• Whiskey. We make circular movements with the fingertips and friction movements with the hypothenar.
• Lower jaw. It must be taken into account that this is the only moving part of the face, so here it is necessary to use movements with pressure, moving them against the direction of movement, towards the temple, while also grabbing the temple.

Zones and points associated with the face:

Despite the fact that these points and zones are not located on the face, working on them promotes significant relaxation. And the state of rigidity and hardening in these areas contributes to tension on the face itself.

• Shoulder - scapula. When massaging the face, it is recommended to capture this area with mobilization movements. In addition, you need to remember that the shoulder-scapula area is directly connected to the cervical area.
• Cervico-occipital (cervical) zone. Working on the cervical area and neck muscles is very important to achieve maximum relaxation. To do this, you can use cervical stretches and mobilization movements along the upper spine and cervical region. Here you can add light pressure on the vertebrae, combining these movements with work on the shoulder.
• Skull area. Here you can use light pressure on the cranial vault and combine them with movements along the cervical area in the form of circunction.
• Temporal lobes. Circular alternative movements with pressure can be used in this area while combining them with mobilization movements on the head. They can also be combined with mobilization movements along the spine (head in flexion position).

You can finish the massage with a relaxing scalp massage.

Highlighting the main thing

To summarize this article, I would like to once again highlight the most important points:

• Before performing a massage, pay attention to the absence of contraindications;
• movements when performing massage for pregnant women should be smoother, slower, more rhythmic;
• do not use intermittent vibration techniques;
• you should not influence reflex points and zones that are associated with the pelvic muscles and the uterus;
• During the massage there should be no pain, it is aimed solely at relaxation, relieving stress and pain;
• a woman who is expecting a child is in a state of heightened emotional sensitivity, so all the massage therapist’s movements should be soft, her thoughts clear, and her heart open.

Source: KOSMETIK international journal, No. 1/2011, pp. 98-101