Originally published in Massage & Bodywork magazine, February/March 2005.
Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.
When a massage therapist gets pregnant, she intuitively wonders how it will affect her practice. While some women experience nausea, others do not. While some women gain only 15 pounds, others gain 50. These individual differences might make it easier or more challenging to continue giving massage. As I write this article in the third trimester of my second pregnancy, I'm exploring how the body's changes during this time can affect a massage practice.Nausea
One of the first signs of pregnancy after a missed period may be nausea. There is extreme variation in the degrees of this ailment, ranging from mild annoyance to violent day-long vomiting. My personal experience has been about four weeks of mild to moderate nausea that comes and goes throughout the day. I was fortunate to have no vomiting as part of it. During my first pregnancy, I worked until my third trimester, while another pregnant therapist quit right away due to extreme nausea. She claimed it totally distracted her from her work so she could not focus on the client. I also had some focus challenges, but was able to find the tools to help.
Ginger is the most popular remedy for nausea during pregnancy. Ginger root powder taken in capsules has been shown in clinical trials to effectively decrease nausea.1
About 250 mg of the powder four times daily is thought to be safe, yet effective. Other remedies prescribed by herbalists include chamomile flowers, black horehound herb, meadowsweet herb, and anise seeds.2
As with all herbs, supplements, and medications, seek out the counsel of your doctor before you begin taking any of these remedies.
Avoiding low blood sugar by eating small amounts of food several times a day can also help. With morning sickness or nausea, one usually does not feel like eating at all, but by eating some crackers or dry cereal, improvement can be felt immediately. It is also thought that vitamin B6 (found in bananas, raspberry leaf, basil, ginger, and peppermint tea) and zinc (found in red meat, pumpkin seeds, green vegetables, or a supplement) can alleviate nausea.3
I must have some guardian spirits working with me, because the few times I could not eat at all, I didn't happen to be working.
The last thing that helped me when feeling "yucky" during a massage was faith in the experience of my hands and in healing spirits that work through me when I'm not feeling my best. As massage therapists, we all have better days than others and different energy levels during our sessions. I like to take solace in the following: The experience accrued in my hands from nine years of massage-giving will always feed my intuition, whether I am aware of it or not; and most well-intentioned massage therapists have healing spirits working through them who aid the clients when needed. So, while it might be harder to focus on a massage session while feeling nauseous, I was reassured I could still help the client by asking for spiritual help and knowing my hands themselves hold powerful experience.Lack of Focus and Stamina
As a pregnancy progresses, women complain of exhaustion, joke about being "spacey" or forgetful, and feel very unmotivated. This makes sense when you look at the increased demands on the pregnant body and the mental adjustment with which the pregnant woman's psyche is grappling. From nausea to aches and pains to amazing fetal movement, the pregnant body takes up a lot of energy and attention, making it difficult to focus on other things.
Some ways pregnant massage therapists can cope with these distractions include rest between clients, not overworking, moderate cardiovascular exercise, stretching, deep breathing, and eating a lot of protein. It is also important to have a little time to yourself while pregnant. By having set times to focus internally, it is less likely exhaustion and lack of focus will distract you from living life. Find brief opportunities to focus within, such as swimming a few laps, doing some favorite yoga poses, listening to music, or simply lying down and breathing into your baby belly. If you are not self-motivated, take a prenatal yoga class or a pregnancy aerobics class. It is not only fun to be around other pregnant women of different body types, but also gives you some tools for home practice. We tend to remember the practices that felt good to our body and can then do them at home. Eating 75-80 grams of protein a day will keep energy reserves up as well.4
An easy way to get that protein is by making shakes with soy or whey protein powder mixed with milk and fruit or ice cream once or twice a day.Presence in Body and Increased Intuition
The flipside of the distraction problems is an increased intuition due to the extreme presence in the body. In learning massage, we realize how important presence in the moment is. As pregnancy makes a woman constantly aware of her bodily changes and the presence of the baby, she is more prone to notice what is happening in and around her. Thus, she may be more aware of a client's body and energy than usual.
In combination with the grounding of pregnancy in the moment, there is an increased production of endorphins.5
These are natural opiates secreted by the brain to counteract pain and create a feeling of well-being. During pregnancy, endorphin production is higher than usual.
Using the power of presence and the high of natural endorphins, a pregnant massage therapist can help clients relax while feeling safe and nurtured and, if needed, release their physical and emotional holding.Changing Posture and Physical Pains
Pregnancy posture is different than normal for two reasons: The expanding uterus moves our center of gravity up and out, crowding the other organs; and hormonal changes, which soften connective tissue, create instability in joints and increase the likelihood of overstretching muscles and spraining ligaments.
As most of the body weight falls forward with this shift in posture, the bony alignment changes and muscles compensate as well. Muscle compensation leads to tension from either shortening or overstretching.
Depending on your body type, postural tendencies, previous injuries, and fitness level going into pregnancy, the changes in body alignment (see specifics on Physical Changes Associated with Pregnancy, sidebar) will affect everyone differently. The best advice to alleviate aches and pains is to practice yoga daily and do some moderate cardiovascular exercise like walking or swimming several times per week. The yoga can relieve specific problems like leg cramps, back or hip aches, shoulder tension, and tingling fingers.6 The general exercise can help circulation and swelling problems, as well as constipation. In addition to yoga and exercise, high amounts of water, protein, and fiber will help soothe many physical ailments during pregnancy.The Obstacle to Good Body Mechanics
At some point during a pregnancy, the abdomen will get in the way of lots of things. In doing massage, this obstacle keeps your hips farther away from the table as you touch the client. This creates more work for the back and shoulder muscles as they keep you from collapsing onto the client. This is counter to what we learn in massage school -- hips being able to move and undulate so that the sacrum and spine stay fluid and free.
During this second pregnancy, I did massage work until my 35th week, which meant I was big-bellied and had only five or six weeks until my due date. I was definitely ready to stop. I experimented with lowering the table. It was too much leaning over for my back and belly while standing and not conducive to sitting, either, due to the baby hitting the table. The solution was elevating the table higher than normal. That way, I didn't have to lean toward the client as much while standing, and while sitting, my belly could expand up below the edge of the table, as my arms worked above.
There are some important things to remember when working as a pregnant massage therapist to protect both yourself and your unborn baby. Now, more than ever, it's essential you listen to your body. Following are my top six bits of advice for ensuring you can work through your pregnancy in the utmost health.
1. Be confident in the strength of your body.
2. Have faith your body will tell you if your actions are not beneficial.
3. Take comfort in the fact your clients come to you largely because of your unique essence rather than your performance.
4. Elevate your table when it feels appropriate.
5. Eat well and drink plenty of water.
6. Practice yoga. Niki Feldman, with a bachelor's in kinesiology, taught massage for seven years. She practices massage therapy, teaches yoga, and lives in Albuquerque, N.M., with her husband and two sons.
1 Brown, Donald J. Clinical Update: Ginger alleviates nausea and vomiting of pregnancy. Herbalgram. 2001;53:21-22.
2 Gaia Symposium. Proceedings on Naturopathic Herbal Medicine. Gaia Herbal Research Institute, 62 Old Littleton Road, Harvard, MA 01457; 1993.
3 Teasdill, Wendy. Yoga for Pregnancy. London: Gaia Books Limited; 1999.
4 Krebs, G. and Brewer, T. The Brewer Pregnancy Hotline -- What Every Pregnant Woman Should Know about Nutrition, Bedrest and Drugs in Normal and High-Risk Pregnancy. New York, NY: Kalico Communications; 2000. Also available at www.blueribbonbaby.org.
5 Teasdill, Ibid.
6 Balaskas, Janet. Preparing for Birth with Yoga. London: Element Books Limited; 1994.