Some massage practitioners refuse to give massage during the first trimester as this is when most miscarriages occur. This is merely because they do not want to be associated with this event should it happen. However, there is no evidence that massage can lead to a miscarriage and massage is not contraindicated during the first trimester. In fact, massage at this time is entirely necessary since it supports a woman as she negotiates the physical, emotional and spiritual changes of her pregnancy. Her potential is maturing into a powerful new role and identity
2) Massage on the legs during pregnancy
Deep vein thrombosis in the legs only occurs in 15 out of 10 000 pregnant women (data from live births in Olmsted County between 1966 and 1995). Of these 12 will have clear signs of a possible blood clot, leaving 3 out 10 000 pregnant women with an undiagnosed blood clot. Despite these low figures, some massage practitioners indicate that massage work on the inner leg is not advisable as it might dislodge an undiagnosed clot. Keeping in mind that massage improves blood flow and thus reduces the risk of a blood clot forming, refusing to give a competent massage on the legs potentially exposes 9997 out of 10 000 pregnant women to unnecessary risk.
A more realistic approach is to give a competent massage while checking for any signs and symptoms of a possible blood clot. The simplistic solution of prohibiting deep massage or massage altogether on the inner legs appears to be more prevalent in countries where litigation is high and seems to be based on misunderstanding and fear rather than on existing evidence-based practice for the following reasons:
- In spite of this exaggerated emphasis on blood clots, no reliable method is given to assess whether a blood clot is present so there is no good reason to either proceed with or stop the massage. Homan’s test is still routinely taught in massage schools to test for deep vein thrombosis even though it is unreliable and is no longer used, other clinical tests being used in its place.
- Massage helps prevent clots from forming by preventing a build up of stagnant blood in the legs. It is very necessary during pregnancy as there is stronger tendency for blood to clot during pregnancy.
- Pregnant women who have been put on bed rest are at greater risk of developing blood clots as their inactivity causes blood to pool in the legs. They are advised to exercise their legs by pointing the foot up and down. This creates a strong pumping action in the calves which helps keep blood flowing through the legs. This has a more powerful effect than massage or work on pressure points. If massage is considered risky, then standard hospital care is even riskier.
- The Spleen, Liver and Kidney meridians of Traditional Chinese Medicine play an important role in health, especially during pregnancy. As they run through the inner legs, work on pressure points in the legs can be extremely beneficial. In particular, it substantially reduces risk in diabetic mothers when their diabetes is a Spleen and Kidney Yang Deficiency type diabetes (here there may not be the excessive thirst, hunger, urination or heat normally associated with diabetes but there is increased risk of incompetent cervix, placenta praevia and detached placenta). Giving only a light, superficial leg massage in this case may expose the mother to far greater risk than a massage of normal, firmer pressure.
3) The use of a belly hole in the massage table
This is done to allow the mother to lie face down without compressing her stomach during a massage therapy session. However, as her stomach is now not correctly supported, her lower back and pelvis are placed under stress and her uterine ligaments are stretched. These are both common causes of pain during pregnancy. The pressure of the hole’s edges on the abdomen also cuts down blood supply to the abdomen.
4) Avoiding lying the back during pregnancy
This ignores that a pregnant women is often positioned on the back for long periods during birth, a common hospital procedure. Only avoid lying on the back in a massage or in general if there is 1) a known threat of blood clots forming in the legs, 2) supine hypotension or 3) lower back pain or pain due to sacroiliac or iliosacral dysfunction.
5) Lying only on the left hand side during pregnancy
It is assumed that lying on the right side will put slight pressure on the inferior vena cava, a large vein carrying blood from the legs and pelvis to the heart. However, although the inferior vena cava lies to the right hand border of the spine, it is questionable if lying on the right hand side can slow down blood flow through this vein. Also, lying on the left hand side puts pressure on the heart and stomach so they may not function at optimum efficiency.
6) The use of contraindicated pressure points
Massage schools teach some pressure points are not to be used during pregnancy as they might induce labour. However they may be used if there is a good reason to use them. If massage could induce labour, abortion clinics would use massage on these points instead of costly medical interventions. Pressure on these points can only induce labour at the end of term and then it is still difficult to do this.
All pregnant women can benefit from pregnancy massage. If at any time during the massage you experience discomfort, tell your therapist immediately.