Debunking myths of massage and shiatsu in pregnancy: part two

How safe is it to have massage or shiatsu in the first trimester of pregnancy?

Following on from my blog on some of the myths around massage and shiatsu in pregnancy, some of you contacted me with some of the myths which are circulating about how safe it is to have massage or shiatsu in the first trimester of pregnancy and also myths around receiving massage at other times during pregnancy.

I have updated this blog in 2018 with some additional information.

If you are a woman looking to receive massage or shiatsu during your pregnancy, then I would suggest that you check the qualifications and experience of your therapist to check that they are suitably trained in pregnancy massage or shiatsu (and ideally birth and postnatal work). While neither massage or shiatsu is unsafe, you will probably find it better to have someone who specialises in this area, unless you have a therapist you have been working with for some time and you want to continue to see them. Some questions you might ask to find the best therapist for you are in this blog I wrote: Finding the right maternity practitioner

You will be pleased to know that in the UK, the FHT recognises my training as providing the level of training for therapists to work safely with women during the first trimester. Fortunately one of their members attended one of my courses when they were about to consider advising that therapists couldn’t offer pregnancy massage in the first trimester. In Australia the Massage and Myotherapy Association, which validated my first course in Australia in 2004 (the first pregnancy massage training in Australia) (formerly AAMT: Australian Association of Massage Therapists) , agreed in 2014 to support pregnancy massage in the first trimester if the therapist had received appropriate training.

There are many myths about having massage in pregnancy, and not just in the first trimester. If you would like more information on any of these do get in touch.

Can’t have a treatment in the 1st trimester. We discuss this in this blog. It is not unsafe to have a massage or shiatsu in the first trimester of pregnancy.
Can’t have a treatment for 3 months after a normal vaginal delivery and for 6 months after a C -section: yes modification is necessary but massage and shiatsu have many benefits. See my blog on this .
Can’t work the shoulders: this is a myth. There is an acupressure point which is powerful and you simply need to know how and when to work it.
Can’t work the legs and ankles (can’t have a pedicure, linked to this). This is about how potentially to modify work, especially if there is oedema or varicose veins.
Avoid so called “induction” points. I have written a little about when to use them however, they are not only about labour: they are womb regulating points.
Can’t massage abdomen. Of course it is different to massage the abdomen in pregnancy, but it is a great way for parents to connect with their baby and supports the abdominal muscles. Here is a way of using the breath to massage the abdomen. Here is an idea of some simple touch.
Can’t work with any woman who is classed as high risk pregnancies: in extreme cases pregnancy is considered a risk
Avoid any deep pressure

I have addressed many of these myths in more detail in my book “Pregnancy and childbirth” and will continue to address them in future blogs. While it is true that some of these indicate modifications to treatment (which is why the therapist needs to know how to modify) they are not contraindications. The only time not to have a massage is when you need medical treatment as a first course of action (eg bleeding). In this blog I am also including a project that one of my students, Lizzie Longhurst, did for her Massage and Pregnancy Diploma on why massage in the first trimester.

I suppose for me the main questions are:

Why WOULD we have massage or shiatsu in the first trimester of pregnancy? The benefits of massage or shiatsu in the first trimester.

I have been working with hundreds of clients since 1990 who are in their first trimester of pregnancy. Many of these have been referred to come to me by their midwife or doctor.

They often come because they are feeling stressed, fatigued or have nausea. I find that their symptoms have usually improved after the session. I have had clients arriving with buckets as they are sure they will be sick: and they have left feeling they want to eat. However, what I find is often as important as relieving symptoms, is that they have some space to be with themselves and to begin to come to terms with their pregnancy, whatever the outcome.

They can also get relief from stress in their neck and shoulders and support for lower back, pelvic issues ( see blog on pelvic instability) which may have become aggravated by the hormonal changes of early pregnancy.

I think I was lucky in my early days as a therapist in that one client came because she had experienced several miscarriages and wanted to try something which she felt might support her. Happily for her and for me, the pregnancy continued till the end and she also went on to have another child. I supported her during her second pregnancy as well. I would never go as far as to say that massage or shiatsu can prevent miscarriage. Miscarriage is in fact a natural process and at least a third, and if we count from the fertilisation of the egg probably more, of pregnancies will end in miscarriage. It is part of life: think of all the seeds which we plant in the soil which don’t make it to maturity. The eggs of our body are rather like that too. However I do believe that with massage and shiatsu we are supporting the body to do the best it can do.

In the past 10 or 15 years, I have had more and more clients coming before they are pregnant, either to support their natural fertility or as part of their support for going through medical reproductive treatments such as IVF. These clients also are often referred by their doctor to reduce stress during this challenging time. I have had women coming at all stages of their medical cycles: around the time of harvesting the eggs and also around the time of implantation. I often include acupressure points (as I do shiatsu as well as massage) and there is increasing evidence of the benefits of acupuncture to support fertility. Even the UK National Health Service has information on it.

What could be unsafe about having massage or shiatsu during your first trimester of pregnancy?

Therapists are often worried that if the client miscarries they might blame the bodywork. My answer to this is

1: Miscarriage is a natural process, indicating either the woman’s body can not accept the pregnancy or that the “baby” (pre embryo or embryo) is not developing properly. Many (at least 1/3) of pregnancies end in miscarriage. There is no mechanism by which massage or shiatsu could cause it. Indeed if it could, then why are women not coming to us for terminations? For me, massage and shiatsu can only ever support the body to process whatever it is going through in the best possible way. We are working with the body’s own resources to enable it to function in the most optimal way.

2: We do need to accept that if we work a lot with clients in the first trimester, by the law of averages, some of them will miscarry. I have never had a client blame me if they have miscarried, indeed the opposite is more likely to be true. They appreciate the support and often come during the process of miscarrying to help them miscarry naturally, rather than needing surgical intervention. They may come afterwards to have support to help them to come to terms with it and prepare for another conception.

3: Surely it is more helpful for women to have a massage or shiatsu, focusing on their body and reducing stress and anxiety, rather than continuing to work in a stressful environment. Are women given time off work? No? So why can’t they have a massage or shiatsu? It doesn’t really make sense.

Find an appropriately trained therapist: pregnancy massage or shiatsu specialist

Here are some excerpts from one of my student’s, Lizzie Longhurst, project www.toptotoetreatmentsbath.com. She decided to write a leaflet for her clients on the benefits of pregnancy massage in the first trimester.

“Even before studying the Wellmother pregnancy massage course, many clients and friends had asked why it is always such a grey area when asking many therapists or spas if they could have a treatment particularly during early pregnancy. Many found that no one would treat them at all during their first trimester. When they asked for explanations they were usually given hesitant replies. These made them feel more anxious about having massage or other body treatments at all during their pregnancy. This was reiterated further during my case study period. I feel that this course has empowered me to treat confidently and appropriately, to refer to other health professionals and when to send for medical treatment when necessary at all stages of pregnancy. To receive positive feedback such as below makes me even more assured that writing a leaflet to help people find out clear information about early pregnancy massage is important.

The massages I have been receiving have been extremely relaxing and soothing, they have helped me with my back pain and shown up other parts of my body that have been under tension without me realising.

Having massages whilst being pregnant has been amazing to help me to relax and look after myself and has reminded me not to push myself too far and to look after my body at this time in particular. The massages have helped my muscles stay relaxed and not tense up as much as they could have done being pregnant and gardening. S. A professional gardener.

Why is the first trimester considered the most unstable and how can massage be of benefit and be safe?

‘My reservation was the myth around having massage before 12 weeks, as we tried to find out at the time and no one would say either way. If I have another baby, I would certainly be interested in having this treatment at least once a month throughout my pregnancy. I felt the massages really helped me. The treatments were an all-round look at your wellbeing and not just a massage.’ C.

The first trimester is the most unstable part of the pregnancy. The fetus develops most rapidly. The placenta is not yet connected to the maternal circulation. If there are any problems here with the cells, the lining of the womb, the levels of hormones, then miscarriage could happen. This fact is one of the causes of anxiety for many women in the early stages of their pregnancy. However as Yates states (p54 2010 Churchill Livingstone). ’the majority of miscarriages are caused by genetic factors resulting in poor development of embryo or placenta. Often the pregnant woman wonders if there is something she could have done to prevent miscarriage. The answer is probably not.’ What is important is to offer a treatment that will help to reduce this potential anxiety during this stage.

You may be concerned that bodywork could be potentially harmful. ‘Bodywork is often no more vigorous than many day to day activities the woman may be engaged in with such as walking to work, exercising at the gym, continuing to engage in sexual activities, running around after toddlers or carrying heavy shopping.’ Yates (p228 2010 Churchill Livingstone)

However as a therapist I would agree that during the first trimester especially to use gentle pressure on and around the pelvic area. This includes both the abdominal and lower back areas. This is being cautious and the client and therapist through consultation and feedback should decide on this as an individual approach to each client.

The massage treatments certainly benefited me in many ways during my pregnancy.

Firstly ensuring that I took time out to relax & do nothing for an hour. It doesn’t matter how many times family & friends would tell me to, I wasn’t very good at it. Booking in the sessions ensured I did. It made me realise how important it was to have that time for me & bump & just think & breathe in the positive calmness & focus on preparing for the birth. S.!

Common conditions:

Softening of body tissue through high levels of the hormone Relaxin and progesterone:

Feeling flexible?

During early pregnancy higher levels of relaxin and progesterone cause ligaments, smooth muscle and connective tissues to soften, especially around the pelvis. On a positive note this can mean that some women will actually have better postural alignment during pregnancy, cf Yates (p.237 2010 Churchill Livingstone). Care does need to be taken in stretches as if there is weakness and instability in the pelvis then this can become exacerbated. One of my clients who I met in her later 2 start of 3 trimester told me:

I wish I had been able to have this type of massage in the first trimester because I had excruciating lower back pain from week 6, but nobody would take me in before 14 weeks. By which time the pain had gone away on it’s own more or less. R

This is such a shame that she could not have had massage at this point as gentle work could have helped to release and ease this and/or I could have referred to her an obstetric Chiropractor or Osteopath additionally if necessary.

Nausea, morning sickness, digestive problems and massage:

As hormones are changing during the first 12 weeks, nausea and actual sickness can mean that you may not feel like having massage at all or are worried that you may be sick. Statistically between 50%-90% of women will experience nausea during the first trimester. Less than 10% will experience nausea throughout gestation. For some of my clients who did have nausea they found eating a little an hour before coming for a treatment and then the actual relaxation of having a massage and the deeper breathing helped.

You could expect to have energy work and abdominal holds if feeling nauseous. Sitting in the semi reclined supine position and avoiding forward leaning would be beneficial, deep breathing and gentle massage for relaxation can help to ease nausea. If hormonal changes are affected due to stress and anxiety then massage can help to relax and therefore calm feelings of nausea.

Constipation may also be experienced (usually worse in first and third trimesters) gentle abdominal massage and energy holds could help to encourage peristalsis as will gentle exercise and drinking plenty of fluid. Rocking and tapping massage techniques would also be avoided. As a qualified aromatherapist I would suggest essential oils such as ginger, spearmint and lavender in a low dilution (1%) in a burner or inhaled on a tissue as they are stomachic, carminative and refreshing.

Sinus congestion and your respiratory system:

When I had a head cold Lizzie concentrated on doing more head massage which really helped me to feel better again after being unwell. This in effect has helped me mentally too. S

S also had sinus congestion in general as did many of my clients. This can often be an issue in the first trimester. It was not something that caused her too much concern, but it was an irritation. This is often due to the increased levels of progesterone and or increased blood volume can cause the capillaries in the upper respiratory tract to swell and therefore cause difficulty breathing. Also in pregnancy you can be more susceptible to picking up upper respiratory infections so this could be a common issue. Some of my clients also complained of difficulty in breathing or shortness in breath (Dyspnoea) due to the increase of pressure on the respiratory system and or oxygenation. As S mentions, head massage can help to release the sinuses and tension around the forehead, eyes, and nose. Massage around the head, neck and shoulders, specifically between the intercostal can help to release and encourage deeper breathing, gentle abdominal massage specifically along the specifically along the diaphragm and around the solar plexus can help you to connect with your breathing.

Positions for massage. What to expect:

In general pregnancy massage during the first trimester could still be experienced either on a massage couch/futon supine (on your back) and prone (on your front) if this is comfortable. A qualified therapist will check if you are comfortable. It is not uncommon to feel pressure lying on your abdomen and breasts from early stages due to hormonal changes, so lying on your side may be more comfortable. During early pregnancy,your blood pressure can lower a little and so a semi reclined position and care getting up slowly from lying down would be advised. Your therapist will check if you are comfortable and you should always say if you feel uncomfortable and if you need to move positions or need to go to the bathroom.”