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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 women’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.
A second trimester woman can lie on her back for part of the massage with a pillow under her right hip. This elevation of one hip is used until 22 weeks to shift the weight of the uterus and baby off the inferior vena cava. Blood flow to the baby may be reduced if the woman were to lie flat during these weeks.
The positioning for massage varies with what trimester the women is in. Generally speaking a woman in her first trimester can receive a massage as she would when not pregnant. Some women experience breast tenderness to the point that laying face down on the massage table isn’t comfortable. When this is the case using a special body cushion with breast recesses makes most women comfortable in the face down position.
Massage can be helpful and safe during pregnancy through all trimesters. With a few precautions and a knowledgeable massage therapist regular maternity massage may become the favorite part of prenatal care for many pregnant women.
After 22 weeks a massage should be given only sidelying or semi-reclining. The sidelying position is the best position for massaging a pregnant woman’s back and pelvis. With the client positioned securely on her side, the massage therapist may then safely apply the deep pressure that may be necessary for relieving strain and tension in the posterior muscles of the back with little fear of increasing intrauterine pressure. The sidelying position is very comfortable with pillows supporting the top leg and arm to align the spine and prevent lumbar strain.
The semi-reclining position will be a modified seated position with a stack of pillows behind the pregnant client to maintain a 45 degree angle from her hip to her head. A pillow or bolster under her knees will keep a bend in her knees and take strain off the low back. With this support, uterine weight will not compress the vena cava as it would in the supine position.
Pregnancy can be an exciting time with many questions as to what is okay and not for the woman and fetus regarding massage. Many differences of opinion and misinformation makes knowing what is okay difficult. Massage is safe during pregnancy as long as the massage therapist has received special training. The changes a women’s body goes through during pregnancy are mind boggling. Understanding these changes and positioning the pregnant client correctly during a massage can make all the difference in safety.