Getting an overview of a client’s health status is an important factor for any massage practice, but it is particularly crucial when working with pregnant women. Gathering information about your client’s physical issues helps the practitioner formulate an appropriate and effective treatment plan.
For the client who is expecting a baby, you need information about her general health as well as how the pregnancy is progressing. And while the baby continues to grow and put demands on its mother’s body, you need to continue to ask her pertinent questions so you can alter your treatment to reflect these changes.
In short, you need a pregnancy massage intake form. Here are five keys points to include.
1. Cover the basics. Your SOAP notes can be adapted to reflect the important questions pertaining to her pregnancy. The usual personal information (name, address, contact information, age) should also include the name of the client’s midwife or obstetrician. I always found this information helpful in case I had any questions about my client’s health. (She gave me permission under HIPAA to speak with her care provider.) It also provided me with a resource for marketing my practice.
2. Does age matter? Maternal age may also be an important factor to consider. While your massage may not change due to the pregnant client’s age, there are certain risk factors that go along with either a younger or older pregnant woman. In this country, pregnant women under 18 or over 35 are considered to be high-risk.
Teenage pregnancy is a major public health issue throughout the world. Among industrialized nations, the U.S. has one of the highest teen birth rates for ages 15-19. Young girls generally do not eat well-balanced meals and are more likely to indulge in such unhealthy habits as smoking and substance abuse. They often are still growing themselves, so their skeletal system, especially the pelvis, has not matured.
Young girls are more likely to have anemia during their pregnancies and hypertension. Because they themselves are still growing, they are more likely to experience preterm labor, have babies with low birth weight, prolonged labor, higher rates of C-sections, and infant and maternal mortality rates.
Women over 35 also run the risk of complications. Although most women in this category have unremarkable pregnancies and uncomplicated labors, there are risk factors associated with advanced maternal age. Older women have a harder time conceiving and are more likely to turn to Artificial Reproductive Technology, which automatically puts them into a higher risk category—although your massage treatment does not change in any way due to this. Genetic abnormalities, particularly Down syndrome, are more prevalent in older women. (It should be noted that older fathers also contribute to these risk factors.)
Glucose intolerance, pregnancy-induced hypertension, prolonged labor and varicose veins are some other risk factors associated with advanced maternal age. But if none of these concerns are present, your massage treatment does not have to make any special adaptations.
3. How pregnant are you? Another important point is gestational age. A trained, certified prenatal practitioner knows how the growing baby affects the mother’s physiology and adjusts her treatment to address these dynamic changes. For instance, in the later months of pregnancy, most women seek extra attention for their backs and legs, whereas in the earlier months, this need is not as compelling.
4. Pre-existing conditions—and how are you feeling? You will want to know about any pre-existing conditions that would influence your care. Then, in her own words, have your client explain how she feels and where she needs most of your concentration. This will help you provide relevant care and organize the treatment around areas that need the most attention. And as her pregnancy progresses, these areas will change.
5. Overview of care. During the initial intake, I take the opportunity to explain what the pregnant client should expect for her treatment. I suggest she give feedback during the massage if anything doesn’t feel right or if she could be made more comfortable with pillow placement.
I show her how to get on and off the table using proper body mechanics so she doesn’t injure her lower back or place undue pressure on the diastasis recti. This means getting up and down in a side-lying position while recruiting her transverse abdominis.
I tell her each massage will be preceded with pre-treatment evaluations for the presence of blood clots or pitting edema. While these tests are inconclusive and subjective, experience and intuition will help determine if the massage is safe.
If you feel you should not proceed, don’t. Have her see her care provider to determine whether or not a massage is appropriate and let her know the leg massage is going to be performed using manual lymphatic drainage to reduce the swelling safely and protect her and her baby from dislodging a potential blood clot. This technique uses light pressure to effectively treat edema.
Training & Attention
Working with pregnant women (and new mothers) requires special training and careful attention. It is an honor and a privilege—and a responsibility—to massage an expectant mother. The questions you ask on your pregnancy massage intake form will help guide you to provide the best, safest care possible.
About the Author
Elaine Stillerman, LMT, got her New York State massage license in 1978 and began her pioneering work with pregnant women in 1980. She developed the professional course “‘MotherMassage’: Massage During Pregnancy” in 1990. She has written four books and in 2013 was named AFMTE Educator of the Year. That same year, she was inducted into the World Massage Festival Hall of Fame.