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	ask the experts elaine stillerman

Elaine Stillerman
Pre and Postnatal Massage Therapy

• The History of Pre and Postnatal Massage
• Fainting during massage therapy
• Deep tissue massage approximately 3 days after conception
• Does my baby feel the massage?
• Which position is the safest and most effective to massage during pregnancy?

Do you know any history on pre and postnatal massage.  I am going to school now for massage therapy and then going back for my certification in pre and postnatal massage.  I was also wondering if you would know any stats on pre and postnatal massage?

Prenatal and labor support "massage" accompanied childbirth nearly everywhere in the tribal world. In the mid-1880's, noted anthropologist George Englemann wrote about the massage techniques used by indigenous people during labor and postpartum. But even before that, some of the first written accounts of labor support came from the midwives in 15th century England. It was a very common practice for these skilled midwives to use a form of massage while the woman was in labor. This made her more comfortable, addressed the issue of back labor and was a reasonably effective pain reliever.

Prenatal massage has enjoyed great recognition and resurgence over the past few decades. Research proves the enormous benefits to both the mother and the developing fetus. Prenatal massage addresses the common discomforts of pregnancy, prepares the woman's body for labor, soothes her nervous system by increasing the secretion of endorphins and serotonin (these cross the placenta and help calm the fetus)and improves her self-image. Massage during labor relieves pain and can shorten labor. Postpartum massage encourages a speedier more effective recovery by promoting the initial cleansing process and, later, by balancing her muscles to their pre-pregnant tone and strength.

It is strongly advised that any massage practitioner wishing to work with this deserving population receive certification from a nationally recognized program, such as MotherMassage.

I was having massage therapy before and during my pregnancy with my first child. When I was about 6-7 months along I was having a chair massage, and my practitioners was working on a "knot" beneath my right shoulder, when I passed out. I have never passed out before or since for any reason, and I found this quite disconcerting! I have also since figured out that I often get either sick or neck rashes after a massage. Can you explain any of this? I admit that I am leery of having massages now.

I understand your concern about receiving massages after this incident, but rest assured that a qualified prenatal practitioner is trained to perform appropriate techniques that will not harm you or your baby.

Let's explore some reasons for fainting. You may have experienced a harmless vaso-vagal response when your shoulder was being massaged. The Spinal Accessory Nerve (cranial nerve XI) follows a similar path as the Vagus Nerve (cranial nerve X) and innervates the sternocleidomastoid and trapezius muscles. One of the effects of this response is a decrease in blood pressure, light-headedness and nausea. You may have fainted as a result of a sudden drop in your blood pressure. Receiving the massage in a chair may also impact your body's ability to circulate blood to your brain.

Another explanation for fainting could be a drop in blood sugar levels. A massage will lower glucose levels for everybody and if you were hungry, or if your levels were low, this may explain your fainting.

As far as the neck rash is concerned, I would ask the practitioner what sort of lubrication she (he) is using and perhaps bring some of your own that you know doesn't cause a skin reaction. Getting sick may also be a function of certain scents in the lubrication or, again, a vagal response.

Perhaps you should try another massage in a side-lying position for additional comfort. But make sure you go to a certified prenatal massage practitioner who can safely address all of your concerns. I wish you a happy and healthy pregnancy.

I had a deep tissue massage approximately 3 days after conception (estimate). The masseuse also gave a deep massage on my abdomen. After this massage. I had abdominal cramps and lower back pain for 24 hours. A week later I feel fine. Did this deep abdominal masage cause any risk to the fetus? Is there anything I should do?

Deep abdominal massage (and deep leg massage) is inappropriate at all times during pregnancy. You are lucky you only suffered cramping and lower back pain.

Three days after conception, the conceptus, now called a morula, is a solid mass of 16 cells that has not implanted into the uterine lining. It will continue to float freely within the uterine cavitiy for another 3-4 days before attaching to the fundus of the uterus.

Almost half of all pregnancies end in miscarriage and about 90% of miscarriages occur within the first 8 weeks of pregnancy. Abdominal trauma is a contributing risk factor to miscarriage and your massage practitioner acted irresponsibly when she did deep abdominal massage.

There is something you can do: you can continue your prenatal massage therapy with a practitioner who is certified in prenatal massage. Be sure to find out where, or if, your practitioner has received prenatal massage certification. Pregnancy massage is enjoying well-deserved recognition but, unfortunately, appropriate education and training are not concomitant with this growing trend.

Note: We received an email from a massage professional who had some concerns about Elaine Stillerman's answer to this question. This professional interpreted that at three days after conception "there is no way for the mother - let alone the therapist - to have known she was pregnant." Elaine had experienced the question differently, and answered accordingly. In the event that other readers were confused, we offer further clarification from Elaine Stillerman:

"The way I interpreted the question, the expectant mother already knew she was pregnant when she had the deep abdominal massage. Some women know the instant they conceive, others have an insight about their pregnancy shortly after conception, so when the writer said that she had "a deep tissue massage approximately 3 days after conception...also a deep massage on my abdomen" you can well imagine why I responded as I did. I delight in pregnant women seeking out the services of qualified practitioners from early in their pregnancies, so there was absolutely no irresponsibility or culpability on the mother's part.

Instead, knowing that she was pregnant (my assumption) lead me to allege that the practitioner was irresponsible when she (he) did the deep abdominal work. If a woman is knowingly pregnant, the responsible way to treat her is to avoid all deep abdominal and leg work.

The answer of risk to the fetus is "yes". Risk is defined as "increasing the possibility of suffering harm, damage, injury , loss or death". Deep abdominal massage during pregnancy, especially in early pregnancy, heightens that risk factor. Does that infer that harm was done. No. But the risk of potential harm is there. Did she miscarry? No, and that is wonderful.

At this point in her pregnancy, the risk from the massage is no longer an issue. She should continue to enjoy and benefit from her prenatal (and postpartum) massages under the care of a qualified, certified prenatal practitioner.

Does my baby feel the massage?

I always recognized that massage during pregnancy has tremendous stress reducing powers, but I was never too sure what the fetus "felt". Over time, however, I witnessed a remarkable similarity in the characteristics and behaviors of those babies whose mothers had regular massage. These newborns seemed to sleep better, eat better, gain weight faster, have sweeter dispositions and fewer or shorter episodes of colic than those babies whose mothers who did not receive massages during pregnancy.

Every emotion has a biochemical component to it. When you feel anxious, for instance, you secrete stress hormones, such as adrenaline and nor-adrenaline. Conversely, when you are relaxed, from a massage let's say, you secrete beta-endorphins which make you feel calm, relaxed and at ease. Since you share a circulatory system with your baby while you are pregnant, it makes sense that whatever you feel is also experienced by the developing fetus.

A 1999 study from the University of Kentucky College of Medicine in Lexington confirmed this hypothesis. Stressed moms produce stressed babies and calm moms produce calm babies. As a matter of fact, the babies of the stressed moms had fetal heart rates that jumped significantly higher and stayed higher longer than the calmer mothers. The study suggests that this can contribute to a higher than normal risk of heart disease and diabetes later in life.

So when you are relaxing during a prenatal massage, trust that your baby is developing in a "sea of tranquility" and is enjoying the euphoria of the massage along with you. She will thank you for it for a long time to come.

Which position is the safest and most effective to massage during pregnancy?

During the first trimester, a woman can safely lay on the massage table prone, face down, provided that she is comfortable. Some women experience breast sensitivity early in the pregnancy and a small hand towel rolled up and placed between her breasts can offset this discomfort.

As the pregnancy continues, one option is the side-lying position. Care must be made to keep her top hip, knee and ankle all on the same level to avoid pulling on the sacroiliac joint. Her knees should be parallel and her neck also must be firmly supported with a pillow.  

Many massage therapists use the body Support Systems (TM) throughout the entire pregnancy. As long as the cushions and bolsters are used correctly, these innovative cushions are orthopedic positioners which help to decompress the lumbar spine and encourage lymphatic drainage, very important during pregnancy. Some massage therapists are concerned about the increase in intrauterine pressure or the pulling on the uterine ligaments in a prone position past the first trimester, but proper use of these cushions avoids any of these problems and is quite safe during pregnancy.

The one position that should be avoided, particularly in late pregnancy, is laying flat on her back or without adequate cushioning. This may cause the heavy fetus to press on the maternal inferior vena cava, cutting off blood and oxygen. Most women start to feel light-headed, dizzy, faint, nauseous or short of breath when this starts to happen.  To position a women in a supine (face up) position, make sure her upper torso is at an angle no less than 45 degrees with firm cervical support. A small pillow under her neck should be just fine.  Her legs should be elevated with optimum pillowing raising her legs higher than her heart. This helps drain her swollen legs and decompresses the lumbar spine.  Some therapists place a small wedge or rolled towel under her right hip to tilt her slightly to the left. This positioning will avoid pressure onto the larger maternal abdominal blood vessels.

The client's comfort is the main issue and she is the best one to decide which of these positions feels right for her and her baby.