Pregnancy is trendy. From expectant celebrities on the covers of People and Vogue to national television features on the do’s and don’ts of the pregnant state, the experience of pregnancy has become part of our social dialogue. Women are anxious to learn what’s best for their bodies and their babies as they move through the 280 days of pregnancy, labor and the postpartum period.
Pregnancy massage and massage for labor and postpartum recuperation are the newest options for women who want an optimum pregnancy outcome. As more therapists are trained to provide pregnancy-specific massage therapy, many women are being exposed to its potential and enjoying its benefits.

Therapeutic intentions
The profound physiologic changes produced by pregnancy necessitate bodywork approaches that enhance well-being and address specific dysfunctions that accompany this state. Medical research has begun to show the importance of autonomic nervous system dysregulation on pregnancy outcomes. In this area especially, massage can have a profound benefit on pregnancy outcomes.
Six months pregnant, Marcy arrived at my office for her first pregnancy massage appointment in a state of high anxiety. She’d learned the previous week that her placenta was attached low in the wall of her uterus. Marcy’s first baby had arrived prematurely; she worried that if her obstetrician put her on bedrest, she’d be unable to care for her son, Justin, or continue working part time as an attorney.
As she settled on the table for a session of side-lying pregnancy massage, I had two therapeutic intentions. I could educate Marcy about the likelihood her low-lying placenta would move upward as her uterus expanded and not endanger her pregnancy. I could also apply soothing and appropriate skin stimulation that would inhibit the outpouring of stress hormones her anxiety was producing.
When women experience stress in pregnancy, blood levels of the neurotransmitters cortisol, adrenaline and norepinephrine surge. Conversely, levels of dopamine and serotonin are suppressed; low levels of these hormones are associated with mood states, such as anger and anxiety.
Not only would Marcy’s continued anxiety fuel more anxiety, it would lead to increased levels of these stress hormones in her body. Recent studies have shown extensive effects on the growing fetus by stress experienced in pregnant mothers. Not only do infants of stressed moms show higher levels of cortisol and lower levels of serotonin and dopamine, they seem to cry and fuss more as babies and perform less well on measures of infant development, such as the Brazelton scale.
Doctors in New York City studied expectant mothers who were in the area of the World Trade Center when it was struck Sept. 11, 2001. They found the infants had smaller head circumferences and were more likely to suffer post-traumatic stress disorder.
Pregnancy massage delivered with a nurturing touch can lower circulating levels of cortisol and norepinephrine, increase levels of serotonin and dopamine, and measurably affect a pregnant woman’s anxiety and depression. The Touch Research Institutes’ (TRI) director, Tiffany Field, has reported that the decrease in stress hormone production after massage lasts as long as two weeks. Therefore, two-week intervals are a good baseline for pregnancy massage sessions. Pregnancy massage also lowers blood pressure, and since elevated blood pressure is a marker of potential complications in pregnancy, this intervention can provide substantial benefit for at-risk women.
With the enormous demands placed on the circulatory system during pregnancy—blood volume may increase up to 60 percent above pre-pregnancy levels—massage is useful in supporting the return of blood to the heart and increasing blood flow to the uterus and placenta. In animal studies, skin stimulation of the abdomen leads to enhanced circulation and has been shown to promote normal placental development. As pregnancy progresses and the uterus enlarges and presses deep into the pelvic bowl, venous return to the heart is hampered. Gentle lymphatic drainage in the third trimester relieves symptoms of edema and heaviness in the legs and feet.

The emotional component
Feelings of ambivalence about her pregnant state, fears for her baby’s well-being and fear of labor are common in a pregnant woman. Massage therapists will likely spend more time with their pregnant clients than their obstetricians or midwives. The educated therapist has a significant opportunity to provide skilled therapeutic touch, reassurance and education to her pregnant client.
Anna Lisa came to my office for massage in her fourth month of pregnancy. Her pregnancy was troubled; she was estranged from her baby’s father and, unbeknownst to her employers, she was attempting to continue her career as a model. Her pregnancy was complicated by body image issues that led to her bulimia as a teenager. During her pregnancy massage sessions, my therapeutic goal was to nurture this emerging mother, as well as her baby, by reassuring her about her appearance and offering encouragement for her to touch and welcome her enlarging belly.
Reva Rubin, a nursing professor at the University of Pittsburgh’s nursing school, was able to show that mothers who received what she called “appropriate, meaningful touch”—back-stroking delivered by office nurses during prenatal visits—were later able to touch their own babies in a “meaningful, effective and caring” way. Other research has shown that the more touch mothers receive in pregnancy, the more likely they are to stroke, smile and talk to their infants, and thus bond with them.
As we see more mothers with children younger than age 3 in the workforce, infants and young children are often cared for in group settings, where there is infrequent touching by caretakers. Child carriers have replaced arms and laps as holders for many babies and young children. Pregnant women who receive massage are far more likely to later massage their babies.

Massage’s benefits
Experiencing regular massage during pregnancy can improve pregnancy outcomes in other significant ways. TRI researchers have found that women who received pregnancy massage had fewer premature births. In 2006, more than 470,000 women in the United States delivered their babies before term (37 weeks or less), putting the infants at greater risk for neurological, developmental and other deficits.
With more women enduring fertility treatments, the number of multiple births has risen in the United States. Mothers of twins are seven times more likely to deliver prematurely; mothers of triplets or more are 20 times more likely to do so. Regular pregnancy massage supports a woman in carrying more than one child closer to term. Kate Bateman, who practices at Kadlec Medical Center in Richland, Washington, recently worked with a woman pregnant with triplets who was hospitalized for a month. She described her 15- to 30-minute massage from Bateman as “the highlight of my day.”
Between 4 percent and 10 percent of pregnancies are considered high-risk because of maternal circumstance (e.g. older than age 40, history of miscarriage), a chronic condition the mother suffers (diabetes, rheumatoid arthritis) or complications (such as high blood pressure that may have developed during pregnancy). Women in high-risk pregnancies often benefit the most from pregnancy massage.
A client named Ning emigrated from China as a teenager. I had seen Ning four years previously for massage during an uneventful pregnancy. This time, her baby had a serious heart defect, and she was naturally very concerned for the baby’s health. Her high-risk specialist readily approved of pregnancy massage as an adjunctive treatment. Ning received weekly massage for the last 12 weeks of her pregnancy, delivering a baby who appeared so healthy the neonatal nurse thought it was her older sister who had the heart defect.
I strongly recommend practitioners providing massage therapy to clients in high-risk pregnancies request medical releases from the individual’s pregnancy care provider. Not only do release forms acknowledge a therapist’s scope of practice, they can allay the fears of a pregnant woman or her family members on the appropriateness or safety of massage for a high-risk

pregnancy.
 Bedrest is often used as a strategy to prevent or postpone preterm labor and to treat other complications of pregnancy. Laurie Aronovici is a labor and delivery nurse at Henrico Doctors Hospital in Richmond, Virginia. She provides massage therapy for patients who have been admitted to the antepartum floor of the hospital on bedrest for a variety of pregnancy-related issues.
The hospital provides information about Aronovici’s services in packets provided to patients. Some travel to her office by wheelchair; those on strict bedrest receive massage in their hospital beds. Bedrest leads to reduced cardiac output and stroke volume, which decreases the ability of the cardiovascular system to return blood to the heart. This effect can be even more pronounced in pregnant women because of the increased thoracic pressure from the enlarging uterus. Gentle Swedish massage and lymphatic drainage techniques can aid venous return to the heart and enhance blood flow to the placenta of a woman on bedrest.
Women placed on bedrest, whether at home or in the hospital, also show higher levels of anxiety, depression and complaints than matched controls not on bedrest. Massage therapy is useful in reducing stress and relieving the musculoskeletal dysfunctions that result from prolonged bedrest. In a hospital setting, massage services are often provided in bed, with allowances made for positioning restrictions dictated by the patient’s doctor. Massage applications can range from “just the feet,” to relaxation/comfort massage, to application of specialized techniques such as strain-counterstrain.
Holly Boyle provides antenatal massage at Anne Arundel Medical Center in Maryland. Patients on bedrest or who demonstrate anxiety or the presence of emotional issues receive doctors’ orders for twice-weekly massage. Boyle has seen consistent reductions in pregnancy-induced hypertension, anxiety and musculoskeletal pain, as well as increased circulation with reduced edema, in her hospitalized clients.
Many pregnant women are aware of the existence of doulas, or specially trained birth attendants. However, they may not know there are massage therapists trained as labor assistants and touch therapists, who can provide sophisticated and skilled touch support and intervention during labor. Labor massage is useful to women having both unmedicated and medicated births.
Labor progress is significantly impacted by a mother’s psychological state. The uterine muscles contract in a nonproductive way when a woman is in a state of high sympathetic arousal, which can be caused by fear, anxiety or severe pain.
Psychosocial factors condition each individual woman’s experience of her labor. An experienced therapist can work with a laboring woman and empower her to cope with the intense stimulus of labor. This work includes focused touch and specific techniques to reduce pain perception and stimulate productive labor contractions.
Deborah Strauhal, a pregnancy-massage therapist in private practice in San Diego, California, has worked as a volunteer doula at the University of California San Diego Medical Center. She has found that younger women are more vulnerable and less prepared for the emotional roller coaster of labor, and skilled touch and reassurance can ease their way in the often alien environment of the hospital birth setting.
Sometimes massage therapists providing labor support do even more. Mary Beth Hastings of Takoma Park, Maryland, recently provided pregnancy massage for a client throughout her pregnancy, and she contracted to provide labor massage at the delivery in a freestanding birth center staffed by nurse-midwives. The client’s labor progressed quicker with her support than the midwives expected. As the mother felt her baby moving down the birth canal and no midwives were available, Hastings helped move the baby out of her mother’s body and into the world.

Postpartum massage
After a baby is born, postpartum massage therapy can alleviate the musculoskeletal complaints of new mothers and provide emotional support and nurturance during their critical life transition. At Boyle’s hospital, postpartum women are seen within eight hours of a vaginal birth and 24 hours after a C-section or other complication of delivery. Clients receive one 20-minute postpartum massage session. Normally, this session is not done using lubrication, unless the patient requests her own cream or oil. 
Except for compression stockings and socks, clothing is not removed, and then only if the client has already been active and the attending RN is notified. Postpartum massage in a hospital setting provides relief of low-back or pelvic pain, relief of spinal headache pain caused by epidural anesthesia, relief of reflex shoulder pain after C-section and general relaxation and sleep promotion. Boyle even found the presence of a massage therapist can be a tactful way for the new family to usher out family and friends who have stayed too long.
Later, in the therapist’s office, postpartum massage can address the musculoskeletal discomfort induced by long hours of baby feeding and care, as well as residual dysfunction that may have developed during pregnancy or labor. Postpartum women need help in reorienting their bodies to post-pregnancy structure. Otherwise, they tend to maintain anterior positioning of the shoulders and pelvic girdle, leading to neck, upper-back and low-back pain later in life. 
The skin and superficial fascia of the abdomen can be treated immediately after birth to minimize the distortion of connective tissue layers that often follows pregnancy.

Professional opportunities
Pregnancy massage is now offered throughout the United States in a wide variety of settings. Individual practitioners, like Gina Buonpane, who owns Every Mother Massage in Oakland, California, specialize in working with pregnant women and their partners through all phases of the childbearing experience, including classes for expectant fathers to prepare for labor. Other practitioners work in obstetricians’ offices.
Aronovici was sent by a large OB-GYN practice to learn pregnancy massage after one of the doctors did an informal survey with 300 maternity patients. They all ranked pregnancy massage as the number one addition they would like to see in their doctors’ practices.
Some massage therapists work in fertility clinics where massage therapy has been seen as useful in relieving high levels of anxiety experienced by women and their partners undergoing fertility treatment. Many U.S. hospitals now offer massage therapy as part of complementary care; therapists work standard shifts, usually seeing patients in one-hour blocks in treatment rooms and in 15- to 30-minute blocks in hospital rooms. Some hospitals also employ massage therapists to provide labor support on an as-needed basis under the direction of attending labor and delivery nurses.
In Madison, Wisconsin, Lisa Shepherd works with an acupuncturist who specializes in pregnancy and fertility issues. She sees most of the acupuncturist’s clients in conjunction with hers, as does Meredith Gade, who works with a chiropractor in Virginia specializing in women’s issues. Physical therapy clinics specializing in women’s health also employ massage therapists.
One of the most rapidly expanding settings for pregnancy massage is the spa. Day spas, hotel spas and destination spas are beginning to offer pregnancy massage to guests. As with other spa services, this may be a setting in which therapists are not adequately trained to provide a safe and appropriate pregnancy massage.
Because of the profound effects of massage on major body systems—the nervous, circulatory and musculoskeletal—any pregnancy massage done with appropriate positioning, observing contraindications for technique and location, will have significant benefits for the pregnant woman, the outcome of her pregnancy and her future family.

Kate Jordan is a nationally recognized expert in pregnancy massage. In her private practice at La Jolla Clinic of Integrative Medicine in La Jolla, California, she specializes in working with individuals with complex medical problems, along with chronic and acute pain, using movement re-education, guided imagery and neuromuscular and osteopathic therapies. She is the developer of the Bodywork for the Childbearing Year and Spa Massage for Pregnancy certification programs, which she has presented throughout the United States for more than 20 years. She can be reached at Kate Jordan Seminars, (888) 287-6860 or www.KateJordanSeminars.com.

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