Monday, October 16, 2017

Rational Prenatal Massage

Prenatal massages are among my favorite massages to give. The absolute gratitude pregnant women express after receiving relief from the increased burden on their bodies reminds me why I wanted to by a massage therapist in the first place. Pregnancy is very taxing; massage provides needed time to recuperate and feel comfortable within your own body again. Prenatal sessions also have the added benefit of treating two humans at once, since it is reasonable to expect that the relaxation felt by the mother is passed via biological signaling (hormonal, biomechanical, etc) to the growing fetus. But, along with every good idea comes a load of really bad ideas, and prenatal massage is no exception. Much to my chagrin, several bad ideas are propagated by educators in my field, the major franchises, and even by the agencies meant to regulate massage.

Massage doesn't cause miscarriage!

If you walk into a major franchise massage chain, and you happen to be in your first trimester, there is a good chance you will be asked to leave. Sure, they'll be happy to take your money when you hit the magical second trimester, but until then it is "no massage for you!" Why? Because of persistent mythology around the effects of massage, and fear of getting sued if you should have a miscarriage. It is suspected that somewhere between 1/3rd and 1/2 of pregnancies end in miscarriage (often without the woman even knowing she was pregnant in the first place), and 80% of those happen in the first trimester. So even though no study has EVER linked massage and miscarriage, and experts suggest moderate exercise and massage may in fact be protective against miscarriage, fear often beats reasoning. As for me, I'm happy to report many women, after rejection from strip-mall massage places, come find me and still get their massage. That is, if they aren't convinced that massage will somehow harm their baby.

Contrary to popular beliefs, there are no magic points on the body that work like a baby eject button. Acupuncture points are silly, inconsistent, and based on pre-scientific ideas. I know that isn't a popular opinion, and frankly, I don't care. Even attempts to directly stimulate such points in overdue (41+ weeks) women ended in disappointment. This has also been repeatedly shown to be true with blinded studies. So much so that Cochrane weighed in on it.

Massage is safe and good (even directly on ankles and feet) for pregnant women.

Evidence of the benefits of massage for pregnant women is actually pretty slim, mainly because it has a certain obviousness to it that prevents researchers from investing time in it. Tiffany Field has made quite a career out of looking at the benefits of massage; I have some ambivalence about her work (especially when it comes to her claims about cortisol) but her research is pretty much the only thing out there right now. Here is a partial list:

"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 tabor and their infants had fewer postnatal complications (e.g., less prematurity)."
- Pregnant women benefit from massage therapy


  • Massage therapy is the most common alternative therapy recommended during pregnancy.
  • Massage therapy has been demonstrated to be effective during pregnancy. The women reported decreased depression, anxiety, and leg and back pain.
  • Depressed pregnant women given the pregnancy massage experienced fewer prenatal complications.
  • In our study on labor pain, the women receiving massage therapy experienced significantly less pain, and their labors were on average 3 h shorter with less need for medication.
  • The most important finding was the lower incidence of prematurity and low birthweight in the massaged depressed women.
  • Postpartum depression and cortisol levels were decreased in the massaged women. The newborns of the massaged mothers also had lower cortisol levels than the newborns of the control mothers, and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales. An underlying mechanism we have been exploring is that these effects are mediated by increased vagal activity.
- Pregnancy and labor massage

Don't even think about talking to pregnant women about "toxins."

Despite the fact that there is absolutely no evidence that massage releases "toxins" and 99% of the time, the person making such a claim can't even define what the word toxin means, let alone which toxins they are specifically worried about, this myth is still floating around. Carrying around a tiny growing person is stressful enough without adding imaginary toxins. So I'll just leave this here:

No, 
No,
No,
And also, no.

Sidenote: You probably don't have to lay on your side either.

Further Reading: https://view.joomag.com/massage-fitness-magazine-pilot-april-2015/0817501001417732043?page=15

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