During pregnancy, a woman’s body typically retains some fluid. So you can expect that at some point in her pregnancy, your client may present with swollen ankles or puffy feet. This excessive swelling, also called edema, is usually not a serious problem; however, the condition can have significant consequences if not addressed. Massage has been highly recommended as an effective way of reducing fluid retention.
Why does edema occur? Changes in blood chemistry foster this fluid buildup. During the third trimester, your pregnant clients may find edema particularly problematic. An enlarged uterus and the growing fetus put pressure on the pelvic veins and the vena cava, causing blood to pool and collect below the knees.
Elaine Stillerman, L.M.T., a teacher of prenatal massage and creator of MotherMassage: Massage During Pregnancy, indicates that by the end of a woman’s pregnancy, she will have 40 percent more interstitial fluid in her body. To release some of this fluid buildup, she recommends a special type of massage using no lubricating product and a slow, gentle stretching technique.
Stillerman suggests using 10 to 30 grams of pressure and begin at the neck, gently stretching the skin and holding for a second with the pads of your fingers. She emphasizes you should always move proximal to distal, with strokes moving toward the heart.
Once you’ve loosened the neck, move to the leg. Using a scooping motion, work on the upper leg, then go to the lower leg, ankle and foot. Since this massage differs from what your client would normally experience, it’s a good idea to inform her before you begin and continue describing the process so she won’t be surprised.
After doing a couple of passes along the leg, wrap both hands around the upper leg, scooping the skin upward, allowing the valves in the vessels of the lymph system to close. As you work the tissue, you may feel slight movement under your fingers, which means you are in the lymph zone, just where you want to be. This type of movement helps stimulate the soft tissues, increasing circulation and reducing fluid collection. It also dispels muscle aches and pains as the lymph is reabsorbed into the system. Best of all, these gentle strokes facilitate removal of waste through the lymph system.
Claire Marie Miller, director of Claire Marie Miller Seminars and creator of Nurturing the Mother, emphasizes your client should lie on her side with the hip, knee and ankle in alignment. She also recommends manipulating the foot with an easy pumping motion to improve circulation, and encourages clients to perform foot circles at home to maintain the benefits of the massage.
Regular massage should help reduce edema, but if chest pains, headache or other pain accompanies the swelling, you should advise your client to consult her obstetrician or midwife immediately. Stillerman notes that continuing this type of massage three months postpartum helps reduce the incidence of blood clots.