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4. Movement: What is the functional movement demonstrated? Is there ease or discomfort? Why do they think that pattern is most effective for them?
5. Testing: Special tests may indicate edema (pitting edema test), high blood pressure, diastasis recti, circulatory issues (such as thoracic outlet syndrome, Allen’s Test, Berger’s Test) and neurological issues (tests for carpal tunnel syndrome or neuropathies).
As health care professionals, when considering the assessments and physiological adaptations, we must strive consistently for a safe, effective, and ethical care. Therapists must consider what is within their scope of care outlined by their governing body. They may have to recognize when a client needs to be referred onward. Building an educated and informed network of care providers will create best outcomes for your clients.
The circle of care should ideally include evidence-informed practitioners, such as physicians, obstetricians, midwives, physiotherapists, and strength and conditioning coaches. To maximize your client’s care, inquire about the quality of training, depth of knowledge, and applications of care. If you have an opportunity to experience their care as a client, you will have a good sense of treatment values and approach.
Busting Myths
Because pregnancy is a normal physiological event, an individual with an uncomplicated pregnancy is in excellent health. They have to be healthy to get pregnant, to stay pregnant, and to give birth. Therefore, critical thinking skills must be applied to any pregnancy massage claim. However, there are common myths regarding massage and pregnancy that could provoke unnecessary fear and stress upon pregnant women. We need to inform our patients about these myths.
Myth #1: Positioning
Many therapists are taught in pregnancy textbooks that patients “should sleep on the left side.” The hypothesis is based on concerns with compression of the inferior vena cava. The primary concern is that the decrease of blood flow returning to the heart would lead to a decrease in oxygenated blood to the mother and her baby. The majority of the research is based on sleeping positions for a night versus 60 to 90 minutes of massage. Research discusses that in a healthy pregnancy, the individual may sleep in any position of comfort.5,6,7 If there is a complication of pregnancy, such as a interuterine growth restriction – small for their gestational age – then the supine position may be a contributing factor to stillbirth.8 The more important consideration is for the pregnant individual to achieve quality sleep. Poor sleep quality can lead to increased incidence of gestational diabetes, depression and high blood pressure.9
The prime differences is that during a massage, a client is awake and can communicate discomforts or symptoms, such as shortness of breath or restlessness. Also, keep in mind that we should be encouraging and trusting the individual to communicate whether they are comfortable or not. If the inferior vena cava were compressed—also known as inferior vena cava syndrome—the common complaints would include supine hypotension, edema in the lower extremities, and a general sense of restlessness. A check-in with a physician would be advised with follow-up pregnancy positioning.
Myth #2: Magic release buttons
There have been beliefs of inducing labour or fears of inducing labour by pressing acupressure points. Research indicates that acupressure or acupuncture is not effective to induce labour.10 Many studies are also flawed as the protocols start at 38 weeks gestation when individuals can spontaneously go into labour, and oftentimes, the sample size is too small to warrant valid and binding outcomes. If massage were effective, then there would be no need for chemical inductions of labour, thus saving the health care system time, money, and beds.
Myth #3: Massage can prevent
stretch marks
Some people believe that massage therapy can prevent stretch marks (striae gravidarum). There are research that review topical formulas that consistently show a lack of efficacy. Topical creams, oils, and lotions have not shown benefits of reducing nor preventing stretch marks. These marks on a pregnant woman are due to a combination of genetic factors, hormonal factors, and increased mechanical stress on the connective tissues. Biopsy of tissue samples have shown a disorganization, shortening and thinning of the elastic fiber network, compared to normal skin samples. Thus, massage therapy can neither change that tissue organization for prevention or repair.
Upon review of the primary concepts outlined above, you may be wondering, “So what can I do as a pregnant client’s massage therapist?” Consider providing support and education in the following ways:
1. Reduce physical discomforts by providing a safe and effective treatment. Be present, compassionate, and nurturing.
2. Provide education about the body’s changes in their skin, center of gravity, and their amazing potential for survival and accommodations of another being.
3. Help empower a peace of mind for pregnant women. Encourage them to ask questions and recognition for their decision-making skills, reminding them that they are individuals of excellence.
References
S. Ud-Din, D. M. (2015, October). Topical management of striae distensae (stretch marks):
prevention and therapy of striae rubrae and albae. Journal of the European Academy of
Dermatology and Venereology, 211-222.
1. B. Farahnik, K. P. (2016, December). Striae gravidarum: Risk factors, prevention and
management. International Journal of Women's Dermatology, 77-85.
1. Reese, M. E. (2015). Hormonal Influence on the Neuromusculoskeletal System in Pregnancy. In C. Fitzgerald, Musculoskeletal Health in Pregnancy and Postpartum: An Evidence Based Guide for Clinicians (pp. 19-39). Switzerland: Springer International Publishing.
2. Rehman, K. s. (2003). Human myometrial adaptation to pregnancy: cDNA microarray gene expression profiling of myometrium from non-pregnant and pregnant women. Molecular Human Reproduction, 9(11), 681-700.
3. Soma-Pillay, P. (2016). Physiological Changes in Pregnancy. Cardiovascular Journal of Africa, 27(2), 89-94.
Clinical Practice Obstetrics Committee. (2013). SOGC Clinical Practice Guideline: Induction of Labour. Journal of Obstetrics and Gynaecology of Canada, S1-S18.
4. Gordon, A. (2015, February). Sleep Position, Fetal Growth Restriction and Late-Pregnancy Stillbirth. American Colelge of Obstetrics and Gynecology, 125(2), 347-355.
5. Fox, N. S. (2018, April). Dos and Don'ts in Pregnancy. American Colelge of Obstetricians and Gynecologists, 131(4), 713-721.
6. Reichner, C. A. (2015). Insomnia and Sleep Deficiency in Pregnancy. Obstetric Medicine, 8(4), 168-171.
7. Radestad, I. (2016, July). Sleeping patterns of Swedish women experiencing a stillbirth between 2000-2014-an observational study. BMC Pregnancy Childbrirth.
Seaward, D. F. (2007, October). When it Comes to Pregnant Women Sleeping, Is Left Right? Jornal of Obstetrics adn Gynaecology Canada, 841-842.
8. Smith, C. A. (2017, October). Accupunture or acupresure for induction of labour. Cochrane Database of Systemic Reviews. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002962.pub4/full
Massage therapy can neither induce labour, cause abortion, or remove stretch marks. What it can do instead is to provide comfort and alleviate stress for the expecting mother.
“Pregnancy is not a pathology. It is a normal presentation of life, like childhood and the elderly.”