When a woman gets pregnant, while generally an exciting time, there is a possibility she may be at risk for developing a health-related problem. Women who already have medical issues, such as high-blood pressure, diabetes, kidney disease, heart problems or some other chronic condition, must be monitored more closely. Even if your client does present with some of these issues, she can still benefit from massage therapy, with a few modifications.
First, your intake form will serve as the basis for treatment. Asking your client why she is considered high risk helps you determine if there are contraindications, according to Julie Robbins, a prenatal massage specialist in Woodbridge, Connecticut. “Make sure your intake form and verbal questions cover all the concerns,” she says.
Knowing the reason your client is considered high risk will also help guide you as you formulate the most appropriate treatment plan and take necessary precautions. Robbins notes that if the client is diabetic, have some candy, juice boxes or granola bars on hand. “Massage as usual, but avoid abdominal massage,” she adds. The same philosophy applies to women with a history of pregnancy loss. “Avoid abdominal massage, mostly to reduce her stress of receiving massage, but also to avoid any chance of contributing to placental disorders.”
Some clients present with high-blood pressure, but when that condition advances into preeclampsia, you should encourage your client to see her doctor or midwife for evaluation immediately. “Common symptoms [of preeclampsia] include pitting edema, severe headaches and visual disturbances, among others. This is perhaps the most important issue to look for in women close to their due date, because a timely response is crucial for the health and/or survival of both the woman and baby,” says Robbins.
Robbins notes, “Many of the issues that create the label ‘high risk’ are unrelated to massage: women over 35 have an increased risk of genetic disorders or stillbirth after 42 weeks, but it doesn’t make massage more or less risky for them. Teens have a greater risk for poor nutrition and, therefore, a less-healthy pregnancy, but their ability to receive a massage is not affected.”
She adds pregnant teens have a higher incidence of sexual abuse, so it is important to reassure them of their safety and their control in the session. “Be very aware of draping, touching and emotional boundaries,” Robbins notes. All regular precautions with HIV-positive people should be observed with pregnant women.
If you are called to provide in-home massage for a pregnant client, avoid any deep pressure since she may be on bed rest or generally inactive. “During pregnancy, the blood’s clotting capacity increases four to five times higher than nonpregnant women. Inactive women have an increased risk for deep vein thrombosis (blood clots), especially in the medial extremities,” says Robbins. “Also, women on bed rest often have muscle atrophy that usually indicates more gentle pressure.”
Robbins advises massage therapists to strike a balance between being condescending and providing so many details about the results of improper massage that the client becomes anxious about unlikely possibilities. “Your client is there to relax. Listen to her concerns carefully and respond with compassion, relevant information and a plan to address her personal issues.”
By asking the right questions, listening carefully to your client and observing any changes, you can bring reassurance and relaxation to your high-risk clients through massage.