5 Prenatal Massage Precautions Therapists Need to Know

“I had my first prenatal massage today (I’m almost 22 weeks), and my massage therapist applied zero pressure on any parts of my body. It was more of just a rub with oil.”

That’s how one Reddit user described her negative pregnancy massage experience. She continued:

“I spoke up and kindly asked her to apply more pressure and she said no—not for a prenatal massage. I was so disappointed.”

No one likes having an unhappy client. Client conflicts spell accidents and sometimes even claims–one of many reasons why insurance is important in the massage industry. But as a massage therapist, you have to prioritize your client’s happiness second, with safety coming first. Yet there are different schools of thought regarding what prenatal massage precautions you should take. Many massage therapists wonder:

• What are the benefits of prenatal massage?
• Are pregnancy massages safe? If so, how long is it safe to get a prenatal massage?
• Who should not get a prenatal massage? What pregnancy massage contraindications do you need to know?
• What massages should be avoided during pregnancy?
• What prenatal massage precautions should I take?

Read on for answers to these questions and more.

What are the benefits of prenatal massage?

When discussing the pros and cons of prenatal massage, knowing the health benefits of prenatal massage can give you motivation to learn more.

Why do people want prenatal or pregnancy massages? According to the American Pregnancy Association, benefits of prenatal massage include:

• Hormone regulation, leading to improved mood management, better cardiovascular health, and fewer birth complications.
• Reduced stress and anxiety.
• Decreased joint swelling or edema.
• Less pain, including back pain, joint pain, muscle tension and headaches, and sciatic nerve pain.
• Better circulation.
• Improved sleep.
• Potentially easier labors. Studies show massages can ease labor pains and reduce labor by an average of three hours.

In an article for the American Massage Therapy Association (AMTA), Dr. Gail Pezzullo-Burgs attested to massage’s ability to address pregnancy pain, anxiety, and decreased circulation.

“Pain is probably the main thing that drives patients to get massage, such as sciatica from the extra weight or position of the baby,” said Pezzullo-Burgs, who incorporates massage into her obstetrics and gynecology practice. “People go through pregnancy in different mindsets, and some are more anxious than others. But I think it also helps reduce their anxiety even if they’re not having pain.”

For Sara Lyon, a massage therapist and founder of Glow Birth & Body, the benefits of prenatal massage go beyond basic pain and stress management. Lyon argues that hormone changes during pregnancy can make prenatal massages better than typical massages.

“[Prenatal massage] takes into account the anatomical and endocrine changes impacting the pregnant body. Prenatal hormones like oxytocin and relaxin are optimal for deep relaxation and tissue healing. It’s an opportunity to take advantage of those hormones and elevate the massage experience,” Lyon explained to The Bump.

Experts across disciplines agree: Prenatal massage can soothe physical and mental pains, helping women take back the joy of pregnancy.

Are pregnancy massages safe? If so, how long is it safe to get a prenatal massage?

Both the American Pregnancy Association and the American College of Obstetricians and Gynecologists (ACOG) agree that prenatal massage is safe. Pregnant women can receive massages at any stage of pregnancy—during the first, second, and third trimester.

If prenatal massage is so safe, why do some massage therapists refuse to give massages to women in their first trimester? Why do they only focus on the benefits of prenatal massage in third trimesters?

Ten to 20 percent of women miscarry within the first 12 weeks of pregnancy. That’s 75 percent of all miscarriages. There is no research nor evidence that links massage and miscarriage. 

Still, miscarriage statistics are enough to scare many massage therapists from prenatal massage in the first trimester.  Despite the many benefits of prenatal massage across pregnancy stages, no one wants a client to accuse them of causing a pregnancy loss.

Who should not get a prenatal massage? What pregnancy massage contraindications do you need to know?

Despite the benefits of prenatal massage, there are some people who shouldn’t get them. Having any of these contraindications would disqualify a client from receiving a prenatal massage. Alternatively, or require them to get they may need prior approval from a health care provider prior to.

Here are some pregnancy massage contraindications from the American Pregnancy Association and the AMTA: 

• Recent bleeding or pre-term contractions.
• High-risk pregnancy.
• Pregnancy-induced hypertension (PIH).
• Preeclampsia.
• Deep vein thrombosis (DVT).
• Placenta problems, including previa, accreta, or abruption.
• Previous pre-term labor.
• Experiencing severe swelling, high blood pressure, or sudden, severe headaches.

While gestational diabetes isn’t a contraindication, it should be mentioned here because it requires extra consideration. Clients with gestational diabetes need their blood sugar levels in control before receiving a massage. Massage therapist Susan Salvo asks pregnant clients with glycometers to check their blood sugar prior to starting and keeps honey packets available for potential sugar level drops. 

What massages should be avoided during pregnancy?

There is no one type of massage that needs to be avoided during pregnancy. Even types of massage known for strong pressure, including deep-tissue and lymphatic drainage, can be okay. However, avoid pressure points or areas like:

• Legs.
• Ankles.
• Feet.
• Belly. 
• Pelvis.
• Wrists.
• Hands. 

These areas need a softer touch to avoid dislodging blood clots or stimulating contractions, explain massage therapists in an article for The Bump.

Another thing to remember is that many essential oils are not recommended during pregnancy because they can cause uterine contractions. Most oils have not (and cannot) be studied on pregnant women, so it’s best to not utilize them during prenatal massage.

Some massage therapists also avoid temperature extremes, like hot stone massages, since pregnant women are advised against raising their core temperatures, writes The Bump.

What prenatal massage precautions should I take?

You now know the benefits of prenatal massage, that pregnancy massages are safe, important pregnancy massage contraindications, and areas and techniques to avoid during prenatal massage. Let’s put it all together to create 5 prenatal massage precautions you should take with all your pregnant clients.

• Do a thorough intake. Massage therapist Kimberly Corpus recommends asking clients about their gestational stage, prenatal diagnosis, past pregnancy problems, medication use, blood pressure, prior bodily trauma, exercise habits, and prior massage history. And since so much can change in just a week of pregnancy, Corpus suggests asking clients to update their information at every session. If a client has pregnancy massage contraindications, get a doctor’s order or wait until their condition clears.

• Keep them hydrated. All your clients should be drinking water before and after their appointments. But pregnant women need even more water to grow their babies. So encourage your pregnant clients to up their water intake before and after their massage.

• Change positions. Flat on the stomach or back just aren’t good positions for pregnant women. Lying on their backs especially can lead to dizziness, weakness, nausea, and shortness of breath. Doctors, midwives, and other experts like Corpus endorse side-lying, especially on the left, for maximum safety and comfort.

• Avoid pregnancy pressure points. Apply less pressure to the legs, ankles, bellies, pelvises, wrists, and hands.. 

• Avoid essential oils. Many doctors won’t recommend massage aromatherapy for pregnant women due to lack of studies on their effects and potential complications.

We’re expecting—and you should be, too.

As massage and bodywork insurance providers, we expect claims. Claims like:

• The peeved pregnant woman who didn’t get enough pressure.
• The disgruntled client who got too little.
• The man that had an allergic reaction due to the massage oil.
• And the woman who claimed her masseuse gave her nerve damage.

These upset customers can walk through your door at any moment. Perhaps some already have. You should expect accidents and allegations like we do. But with us in your corner, they don’t have to scare you.

Our massage therapist insurance covers common claims from accidents and negligence for as little as $159 a year. Click here to check pricing.