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Which Position is Best? (For Prenatal Massage)

As a Registered Massage Therapist and Doula, I do a lot of Prenatal Massage!

So much so that in 2019, I decided to further my training and dive deeper into the study of Prenatal Massage and train with Trimesters Massage Therapy Education to learn the ins and outs of prenatal massage.

That allows me to join the ranks of only 2 other therapists on the whole island with this training!!

My techniques continue to evolve, shift and improve but one thing that remains a constant with my practice is the way in which my clients are positioned.

Let's discuss it!

So, first of all, a disclaimer: there are very little studies on the positioning of pregnant clients for massage so we are going to base this post on our understanding of body structures, gravity and the little evidence we do have.

What we do know:

When placed in a prone position (belly down), either flat on the table or using a pregnancy table or cushion, it shortens the posterior musculature (back muscles), compresses and anteriorly (towards the front) displaces the vertabrae.

(This position is usually fine for practitioners who may treat for much shorter lengths of time; chiropractors, physiotherapists, etc)

It also places more strain on the SI joints and the sacrouterine ligaments.

Due to the length of a massage treatment (usually 60 minutes, sometimes 90) and the depth of pressure needed to work the posterior structures, we know that a prolonged prone position can increase the likelihood of strains, pain and discomfort and increased intrauterine pressure (which can irritate the uterine muscles which may lead to contractions).

It's very simple to understand if we consider the weight of the pregnant body plus the pressure from the table/cushion plus the RMT's body weight. Even in the pregnancy table with an adjustable sling, there is still increased pressure on the abdomen.

During the first trimester, when the uterus is generally protected by the pelvis, a belly down

position is usually fine. (Exceptions to be made for folks pregnant with multiples)

There are usually modifications to ensure comfort in the breast region, as it is a common first trimester symptom to have tenderness in that area.

*Towels and Pillows can be used to support the chest and reduce pressure during the first trimester.*

For the duration of the pregnancy, a supported sidelying position is the best for safety, comfort and for access to common "problematic" areas: hip, shoulder, back.

In a sidelying position, we can very effectively address issues with the fascia, muscular tension and perform low grade joint play and traction.

As a holistic provider, it is always important to me to not only support the physical body but also the emotional.

A side lying position allows for conversation, in an easy and safe position to discuss fears, joys, feelings, etc. For some folks, this ability to share in a non judgemental, informed space is an essential part of their stress reduction. (Not to mention the opportunity to pick a doula's brain!)

We all know how important stress reduction is! Pregnant or not.

In the treatments I provide, the majority of the treatment is spent in sidelying, supported with many pillows.

The other position I use is semi reclined. After the back and legs and feet have been treated, the client moves into a supported semi reclined position.

Using a large firm cushion, designed to support the body from bum to shoulders, plus more pillows for comfort, this position allows a deep working of the shoulders, neck and arms and if the client desires, a relaxing abdomen massage as well.

A semi reclined position (rather than a flat on the back position), reduces the compression of the inferior vena cava from the weight of the uterus.

*Extended vena cava compression will result in low maternal blood pressure and decreased maternal and fetal circulation.

Signs of this are: uneasiness, dizziness, weakness, nausea and shortness of breath.

This is truly not something to be overly concerned about. It is instinct to move our body if we are in a position that is compressing our veins, before it becomes a danger.

Overall, we know that a sidelying position is the best for comfort and safety.

Despite my initial fears of potentially losing clients due to their preference of a prone treatment, having this specialized knowledge and wisdom and experience has increased my client load AND my comfort level with treating the pregnant body!

I highly recommend seeking out a massage therapist with this training for your prenatal treatments! (As always, I am taking new clients!)

This year I will be returning to Trimesters to take their Infant and Child Massage Training, so that I can continue to treat the babies after they make their way earthside!


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