Nurturing touch during pregnancy, labour, and the postpartum period is not a new concept. Cultural and anthropological studies reveal that massage and movement during the childbearing experience was and continues to be a prominent part of many cultures’ healthcare.1 Studies indicate that most of the more peaceful cultures use touch prominently during pregnancy and early childhood.2 Midwives, who for centuries have provided maternity care, have highly developed hands-on skills.

Current research on the benefits of touch is providing a contemporary basis for its reintroduction in many technological societies, including the United Kingdom. Scientists have found that rats restricted from cutaneous self-stimulation had poorly developed placentas and 50% less mammary gland development. Their litters were often ill, stillborn, or died shortly after birth due to poor mothering skills.3 Pregnant women massaged twice weekly for 5 weeks experienced less anxiety, leg and back pain. They reported better sleep and improved moods, and their labours had fewer complications, including less premature births.4 Studies show that when women received nurturing touch during later pregnancy, they touch their babies more frequently and lovingly.5 During labour the presence of a doula, a woman providing physical and emotional support, including extensive touching and massage, reduces the length of labour and number of complications, interventions, medications, and Caesareans.6

Why Prenatal Massage Therapy?

Profound local and systemic changes in a woman’s physiology occur as a result of conception and the process of labour. Changes during pregnancy span the psychological, physiological, spiritual, and social realms. Massage therapy can help a woman approach her due date with less anxiety, as well as less physical discomfort.

A typical session performed by a practitioner specialising in pre- and perinatal massage therapy can address pregnancy’s various physical challenges: oedema, postural changes, and pain in the lower back, pelvis, or hips. Swedish massage may facilitate gestation by supporting cardiac function, placental and mammary development, 7 and by increasing cellular respiration. It also reduces oedema and contributes to sympathetic nervous system sedation.8 Deep tissue, trigger point, and both active and passive movements alleviate stress on weight-bearing joints and myofascial structures, especially the sacroiliac and lumbosacral joints, lumbar spine, hips, and pelvic musculature.9 Specific structural balancing techniques and postural re-education reduce neck and back pain caused by improper posture and strain to the uterine ligaments. Prenatal massage therapy can also facilitate ease of labour by preparing the muscles for release and support during childbirth.

Beyond these physical effects, an effective prenatal massage therapy session provides emotional support. In the safe care of a focused, nurturing therapist, many women unburden their worries, fears, and other anxieties about childbearing. Massage therapy by a trained touch specialist can help the mother-to-be develop the sensory awareness necessary to birth more comfortably and actively. Labouring women whose partners learned and provided basic massage strokes to their backs and legs had shorter, less complicated labours.10

The Postpartum Period

Beginning with the baby’s birth, a new mother must cope with more changes. She is typically only 10 to 12 pounds lighter, yet she is still maintaining her body with an anterior weight load posture. The maternity massage practitioner can facilitate proprioceptive reprogramming to gently return the body to its pre-pregnancy state, to alleviate pain, and to bring about a renewed sense of body and self.

As a specialist in postpartum work, practitioners can focus on repositioning the pelvis and re-patterning overall body use. Postpartum massage sessions can restore functional muscle use in the lumbar spine area, as well as strengthen and increase tonus in the abdominal musculature stretched and separated by pregnancy. Additionally, the overtaxed, hypotoned iliopsoas muscle functions can be improved. Upper back muscles which now support larger breasts and the carried infant’s weight need work to reduce strain, and to help maintain flexibility despite the physical stresses of infant feeding and care. For post-Ceasarean mothers, specific therapeutic techniques also can reduce scar tissue formation11 and facilitate the healing of the incision and related soft tissue areas, as well as support the somato-emotional integration of her childbearing experience.

Pre- & Perinatal Massage Therapy Education

To safely massage pregnant, labouring and postpartum women, it is imperative that practitioners be knowledgeable about normal pre- and perinatal physiology, high risk factors, and complications of pregnancy. Many of these conditions necessitate adaptations and consultation with physicians and/or midwives prior to sessions. Various techniques and methodologies must be modified or eliminated, depending on the individual and the trimester of pregnancy.

Practitioners will find reliable detailed, research based protocols and contraindications in the book, Pre- and Perinatal Massage Therapy. For those seeking comprehensive hands-on training as a maternity massage specialist, I recommend a 32-hour certification course to qualify.

Instruction offers practitioners a safe and comprehensive approach to pregnancy, labour, and postpartum massage therapy. I also encourage an empathetic, non-judgmental attitude in supporting women’s ‘pregnant feelings’. The course includes over 80 techniques specifically adapted for pre- and perinatal needs, and they include the practical marketing strategies, ethics, and skills to elicit collaboration with other perinatal specialists and to build a successful maternity massage therapy practice.

Research supporting massage therapy and pregnancy

Pregnant women benefit from massage therapy.

Field T, Hernandez-Reif M, Hart S, Theakston H, Schanberg S, Kuhn C.

Touch Research Institute, University of Miami School of Medicine, USA.

Twenty-six pregnant women were assigned to a massage therapy or a relaxation therapy group for 5 weeks. The therapies consisted of 20-min sessions twice a week. Both groups reported feeling less anxious after the first session and less leg pain after the first and last session. Only the massage therapy group, however, reported reduced anxiety, improved mood, better sleep and less back pain by the last day of the study. In addition, urinary stress hormone levels (norepinephrine) decreased for the massage therapy group and the women had fewer complications during labour and their infants had fewer postnatal complications (e.g., less pre-maturity).

Publication Types:

• Clinical Trial
• Randomised Controlled Trial
PMID: 10212885 [PubMed -
indexed for MEDLINE]

Labour pain is reduced by massage therapy.

Field T, Hernandez-Reif M, Taylor S, Quintino O, Burman I.

Touch Research Institute, University of Miami School of Medicine, USA.

Twenty-eight women were recruited from prenatal classes and randomly assigned to receive massage in addition to coaching in breathing from their partners during labour, or to receive coaching in breathing alone (a technique learned during prenatal classes). The massaged mothers reported a decrease in depressed mood, anxiety and pain, and showed less agitated activity and anxiety and more positive affect following the first massage during labour. In addition, the massaged mothers had significantly shorter labours, a shorter hospital stay and less postpartum depression.

Publication Types:
• Clinical Trial
• Randomised Controlled Trial
PMID: 9443139 [PubMed -
indexed for MEDLINE]

Footnotes:

1 Goldsmith, Judith. Childbirth Wisdom. New York: Congdon and Weed, 1984.
2 Prescott, James. The Origins of Love & Violence and the Developing Human Brain. Touch the Future, Long Beach, CA, Fall, 1995, pp. 9-15.
3 Rosenblatt, J.S. and D.S. Lehrman. Maternal behavior of the laboratory rat. Maternal Behavior in Mammals, Wiley, New York, 1963, p. 14
4 Field, T., M. Hernandez-Reif, S. Hart, H. Theakston, S. Schanberg, and C. Kuhn. Pregnant women benefit from massage therapy. J. Psychosomatic Obstetrics and Gynecology, 20(1), March, 1999, 31-8.
5 Rubin, R. Maternal Touch. Nurs Outlook, 11/1963, ppp. 828-31.
6 Kennell, J.H., M.H. Klaus, S.Robertson, C. Hinkley. Continuous emotional support during labour in a US hospital. J Am Med Assoc, 265, 1991, pp. 2197-2201
7 Rosenblatt, op sit, 14.
8 Zanolla, R., Monzeglio, C., Balzarini, A., et al. Evaluations of the results of three different methods of post-mastectomy lymphedema treatment. J. Surg. Oncol. 26:1984, p. 210-13.
9 Quebec Task Force on Spinal Disorders. 1987. Scientific approach to the assessment and management of activity-related spinal disorders. Spine, 12:, Supplement 1.
10 Field, T., Hernandez-Reif, M., Taylor, S., Quintino, O. Touch Research Institute, University of Miami School of Medicine and Iris Burman, Educating hands School of Massage Therapy. Journal of Psychosomatic Obstetrics and Gynecology, (in press 1998).
11 Hufnagel, V., M.D. “Medical basis for using massage after surgery.” Massage Magazine #17, Dec-Jan/1988-89, p. 21

To order a book or to learn more about the Pre- & Perinatal Massage Therapy course for September in Scotland, call the local sponsor, Ronnie Allan on Tel 01655 882742 or E-mail randmallan@aol.com. For Ireland, call local sponsor James Earls on Tel 028 9059 0594 or E-mail jearls@eim.dnet.co.uk You can also call Body Therapy Associates at 001 858 748-8827 (U.S.A). Website: www.bodytherapyassociates.com