You may have heard this from the doctor about sleeping on your back. The inferior vena cava is the major vessel of blood return to the heart. The growing uterus and fetus can put unwanted pressure on the vena cava possibly resulting in low maternal blood pressure and decreased circulation both to the mother and her baby. Some women report dizziness, shortness of breath, or other discomforts when lying flat on their backs, others however seem perfectly content. Whether a woman feels fine or not, decreased fetal circulation occurs. After 22 weeks it is best to receive massage semi-reclining to prevent decreased fetal circulation.
I've heard about special massage tables or cushions with a cutout for my stomach?
The positioning for massage varies with which trimester the woman is in. Generally speaking, in the first trimester the woman can lie as she normally would when she's not pregnant. In the second and third trimesters, the massage will be given sidelying and semi-reclining. The sidelying position uses lots of pillows and most women find it very comfortable. Another safe position for prenatal massage is semi-reclining. This position is achieved by creating a stack of pillows behind the woman so when she leans back she is sitting at about a 45 degree angle. Read more about positioning and safety.
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Certain Chinese acupuncture points can initiate and stimulate uterine contractions. Instead of using acupuncture needles, massage therapists use finger pressure or acupressure. These points can be used after 40 weeks of pregnancy but are contraindicated prior to a woman's due date. The points are named Liver 3, Kidney 3, and Spleen 6. Liver 3 is on top of the foot. Kidney 3 is located on the inside ankle and Spleen 6 is the inside shin area. To stimulate contractions, repeated and prolonged pressure is applied to these points.
I understand after weeks of being pregnant the thought of lying face down can be very appealing. Beginning week 14 laying face down (prone) is not recommended, even with specialized equipment such as "cut-out" tables or cushions. It is believed that strain to the sacrouterine ligament is likely when lying second and third trimester women prone on the table. This ligament holds the uterus to the spine. The uterus is housing the developing fetus and keeping it safe. It is best not to take any chances with disrupting the uterus and the ligaments that hold it in place. If the strain of gravity during a prone position is a concern then additional strain placed on the ligament when the massage therapist begins to massage the woman's back is of greater concern. The additional weight and pressure applied to the back during prone procedures may significantly increase intrauterine pressure. Again, no undue strain to the developing fetus is wanted or necessary.
Also in the later stages of pregnancy many women are experiencing back pain. To lie them on the table face down shortens posterior musculature, compresses the lumbosacral junction, and rotates the sacroiliac joints. This prone position aggravates the very causes of many women's back discomfort.