To complement the MASSAGE Magazine article, “Maternity Massage Therapy for Pregnant, Laboring and Postpartum Women,” by Carole Osborne, in the October 2010 issue. Article summary: Maternity-massage therapy is one of the most personally rewarding and professionally satisfying massage-therapy specializations. Maternity massage addresses the many needs of women throughout an entire childbearing cycle, rather than just during pregnancy. If you are considering entering the world of bellies roiling with life, labor’s powerful groans and the sweetness of a mom embracing her newborn, you will need a sense of what this really entails.

by Judith Koch

Much has been written about special concerns for massaging women during pregnancy, but less attention has been paid to the topic of postpartum massage. The postpartum period is defined as the length of time it takes the uterus to return to its nonpregnant size, which is generally six weeks. During this time, massage therapists should still give consideration to positioning and modifying abdominal bodywork.

During the first week or two of the postpartum phase, the uterus can still be quite large and continuing to contract. The breasts are also often quite tender, as they become engorged and as the nipples adapt to the effects of suckling the newborn. As a result, the massage therapist should give the client the option to continue in a side-lying position to keep pressure off of the chest and abdomen.

If the client prefers a prone position, a soft, round cushion placed on the table below the shoulders and just above the breasts can help take pressure off the breasts. Often by the end of the second week of the postpartum period, the client is perfectly comfortable in a fully prone position.

While performing your abdominal routine, you may feel the uterus contract. Firm pressure to the uterus, although it may cause some discomfort in the form of cramping, is indicated during the postpartum period. Immediately upon delivery, the medical staff often performs very firm compressions to the uterus to promote contractions.

This is important to prevent hemorrhaging. When the placenta is delivered during the third stage of labor, it essentially leaves an open wound to the uterus, much like a wound when a scab has been picked. The compressions cause the uterus to contract, which helps to close off the blood flow. By massaging the uterus during your postpartum massage sessions, you are encouraging it to continue to contract and return to its normal size.

Another thing to look for is to see if the pregnancy caused a separation (diastasis) along the linea alba, which runs between the left and right rectus abdominis muscles. This can be easily detected by firming placing your fingertips, parallel to the linea alba just above or below the naval, and pressing in slightly as you have the client contract her abdomen by bringing her chin toward her chest, as if doing a mini sit-up.

As the muscles contract, if one or more of your fingers drop into a depression between the two rectus muscles, it would indicate a separation. If you find this separation, you should advise your client to bring the muscles together (either by placing a belt or towel around the waist and bringing the two ends together, or by crisscrossing her hands across her waist and pulling them together) when performing any abdominal exercises. This will train the muscles to remain side-by-side as they are strengthened.

These techniques can help your client return to normal more quickly after giving birth, which will make her eternally grateful.

Judith Koch is the director of education with the Institute of Somatic Therapy, and founder of the Massage Doula Network. To learn more about serving your clients during their childbearing years, visit