Walking into the waiting area, my new client is sitting with a smile and a sizeable baby bump. I offer congratulations along with, “If you’re ready, let’s head this way…”
On the short jog to the massage treatment room, I go over my mental checklist of items I’ll want in the room: body pillow, extra bolsters, support wedge. I close the door and ask my standard, “So, what brought you in for massage today?”
She replies, “I’m seven months pregnant, and my feet are killing me. But I’ve heard massaging feet can be risky, so maybe just focus on my shoulders?”
My mood deflates somewhat as I’m faced with a choice I’ve made countless times with pregnant clients: get on my soapbox, or just get on with the massage? Share facts, at the risk of causing friction, or just provide what she requested, and perpetuate fiction?
A spiral of unknowable, anxiety-amping questions pop into my head:
- What if I make her uncomfortable by “correcting” what she thinks is true?
- What if instead she’s glad to not have to worry about ankles anymore?
- What if she’s actually open to learning about what research says?
- What if she in turn gets really offended and then tells all her friends?
- What if it’s the ethical thing to do and her reaction doesn’t matter?
What if she complains to my boss and I’m told to stop educating clients?
- What if…
As the thoughts spiral, I land back to the original dilemma: do what’s right or stay quiet?
Is Massage Therapy Safe During Pregnancy?
Many Massage Therapists who provide prenatal massage have run into situations like the one above.
There are several rooted old wives tales and myths surrounding massage and pregnancy. As Massage Therapists, we have a great opportunity to provide context, debunk pseudoscience, and encourage our clients to enjoy the benefits of massage during their pregnancy.
Yet in doing so, we may cause friction.
Especially with new clients, where rapport has not yet been established, confronting or correcting personal beliefs could be a bit touchy.
Simply put, there’s no evidence that effectively demonstrates massage can induce labor, cause miscarriages, or create complications. Just because someone’s great aunt said so, or a neighbour went into labor after a pedicure, doesn’t make it true.
Physiologically, there’s no reason a pregnant woman couldn’t enjoy the same massage as someone who is not pregnant would. Pregnant women are not sick; nor (in general) do they have a condition that can be worsened through massage.
They are often understandably sore, tired, or uncomfortable, but pregnancy itself is not an illness. Additional pillows, supports, or body positions may be required, but those types of accommodations should come naturally to any client-centered massage practice.
A few times, I’ve been asked if I hold some type of prenatal massage certification?
I reply that I do not, and do not believe it is necessary. Which is normally followed up by, “So what exactly is your prenatal massage?” My honest answer is, “It’s my same great massage… but with more pillows.”
While countless changes occur in the body during pregnancy, in general, the body is not altered to the extent that licensed/registered professional Massage Therapists need additional credentials in order to provide their own same great massage. Muscles are still muscles, joints remain joints, nerves stay nerves. The effects of massage on those tissues remains the same.
However, just as you would with any client, if there’s a health condition, or a known complication, defaulting to having massage ran by their doctor is prudent.
Examples include diabetes (diagnosed before or during pregnancy); high blood pressure; cancer; and heart, kidney, lung or liver disease. Those conditions are not always contraindications, and clients with them may really benefit from massage, but they may act as cautions and reasons to alter your typical protocol.
What About Massaging The Feet And Ankles?
Do a quick Google search and you’ll come across countless articles, blogs, and opinions that warn pregnant women against ankle massage because it could induce labor.
Chances are, many women may have at least heard of this myth, and some may become apprehensive or avoidant of massage because of it.
When you try to locate legit sources for such claims, you’ll hear crickets chirping.
There’s no evidence that applying pressure to points on the feet or ankles will in turn cause uterus contractions. This wide-spread myth stems mostly from Reflexology.
Reflexology is a belief system that points on body relate directly to various internal organs, and by pressing or massaging those points, we can stimulate those organs. The claimed points for the uterus and ovaries are on the ankles.
But if that’s not enough, there was a great study in 2014 where researchers attempted to induce labor in 221 post-due date women by applying acupuncture needles to the specific labor-inducing points. Even when poking these gals every other day for a week, none of the findings supported reflexology claims. If they couldn’t induce labor with that amount of poking, general massage of the ankles is never going to do the trick.
Not only is there no evidence to back up the myth, there’s also no plausible reasoning to explain how it might work. What biological function is present in the ankles that would influence the uterus so? A super long nerve?
If pressing on ankles did influence labor, it would be risky to wear high top shoes, or even walk about daily life, for fear of bumping into or tripping over something with the feet.
Lastly, if it were just that easy to kickstart the birth process, docs and nurses would be spending much more time on women’s feet in the delivery room, and the use of hormones to induce labor would be obsolete.
Benefits Of Massage Therapy During Pregnancy
Moving beyond the fiction and into the facts, research has shown some positive preliminary evidence of the benefits of pregnancy massage.
Everyone can benefit from being less stressed, but for pregnant women in particular, less stress for them also translates into less stress for the growing baby.
A 2010 systematic review concluded that pregnant women reported decreased depression, anxiety, leg and back pain post-massage. Cortisol levels (the stress hormone) also decreased, excessive fetal activity decreased, and the rate of prematurity was lower.
Many of my clients have expressed how taking time to relax has also given them an opportunity to “check in” and more deeply appreciate their changing body. It’s provided time for reflection and appreciation for the child they are eagerly anticipating to meet soon.
A 2015 randomized control trial concluded that massage therapy can reduce lower back pain during the first postpartum month.
Narratively, I have treated pregnant clients for symptoms also expressed by the vast majority of my non-pregnant clients. Swelling, achy joints, nerve pain, sore muscles and compensation due to shifts in weight and posture, tension headaches, etc.
By applying the same anatomy and evidence-based training we would with any client, Massage Therapists can effectively address the aches and pains pregnancy can bring.
Effective Communication About Pregnancy Massage Myths
Back to the example with my client at the beginning of this article, that day I did opt for the soapbox.
I took a long deep breath and rolled the dice, “Before we begin your massage, can you tell me a bit more about why massaging your feet may be risky? If they’re causing discomfort, I may be able to provide you with some relief today…”
I’ve found it’s helpful to ask a client to clarify their concern. Their response gives me more information to work with when attempting to tactfully dispelling potential myths:
What have they heard?
- Are they concerned about the entire foot or just specific points? If only specific points, perhaps there’s room to compromise. I can offer a massage of the foot but avoid ankles.
Where have they heard it from?
- What’s the context? If a client saw a Facebook post warning about ankles and pregnancy, information in that context is typically much easier to confront as false.
How convinced are they?
- Can they be persuaded or not? If their source is a favorite reflexology practitioner they’ve been seeing for various ailments for years, I may cause considerable friction attempting to counter those beliefs. However, if their source or conviction is uncertain or weak, that may be a door open for continued conversation.
In the few cases I’ve experienced where a client is just not convinced, it has carried some friction (not the beneficial kind) into the massage and I did not see those clients again. Although I hate to lose a client, I take some comfort in knowing perhaps they will at least second guess the myth, maybe do research of their own, and in a best case scenario, perhaps allow another Massage Therapist to relieve their achy feet in the future. I hope others will join me in leaving this particular massage myth behind, continue to help women feel better, and support the on-going pursuit of further evidence to advance massage. In the case I’ve cited, my client’s source and conviction was weak, so I took the chance and briefly recapped the evidence-informed perspective I had to share. I’ll never forget her response: “Then this isn’t an old wives tale, it’s an old husband’s tale. My husband’s got a foot massage backlog to catch up on now.”