High-Risk Pregnancy: Massage Caution or Contraindication?
Women with high-risk pregnancies are often deprived of bodywork, even though they can benefit the most. Differentiation between a massage caution and massage contraindication will guide therapists with a desire to work with high-risk pregnant clients.
by Nicole Cutler, L.Ac.
Its ability to improve many aspects of both physical and emotional health makes the benefits of massage therapy extremely far-reaching. Because of the major structural, physiological, psychological, spiritual and social changes that occur during pregnancy, massage is especially valuable to women at this juncture in their life. However, massage therapy is commonly denied to those who could benefit most from bodywork - women with high-risk pregnancies. By learning more about expectant mothers in this category, bodyworkers can distinguish between pregnancies requiring additional care and situations that carry too great a risk for bodywork.
Defining High-Risk Pregnancy
According to the respected physician's reference, the Merck Manual, there is no formal or universally accepted definition of a "high-risk pregnancy." Despite the casual reference, experts agree that a high-risk pregnancy involves at least one of the following:
1. The woman or baby is more likely to become ill or die than usual.
2. Complications before or after delivery are more likely to occur than usual.
Certain conditions or characteristics qualify a pregnancy as high risk. Approximately 5 to 10 percent of all pregnancies in the U.S. fit into a high-risk category. Although not a comprehensive list, the most common culprits for placing a pregnant woman in a high-risk category include:
· Age - A mother under age 15 or over age 35
· Diabetes - Having diabetes prior to pregnancy or developing it during pregnancy (gestational diabetes)
· Pre-eclampsia - A syndrome that includes high blood pressure, urinary protein, and changes in liver enzymes during pregnancy that can affect the mother's kidneys, liver and brain
· Multiple Pregnancy - Carrying more than one child at once increases the stress on the mother's body
· Other Pre-existing Health Conditions - Asthma, high blood pressure, cancer and heart, kidney, lung or liver disease
Massage for High-Risk Pregnancy
The benefits of prenatal massage are not contested; in fact, they are even proven. In a 1999 study published in the Journal of Psychosomatic Obstetrics and Gynecology, prenatal massage decreased anxiety and stress hormones, resulting in fewer obstetric and postnatal complications, including lower pre-maturity rates.
Prenatal care for women with a high-risk pregnancy typically involves extensive testing, more frequent prenatal visits, medications and bed rest. Unfortunately, the stress of worrying about one's own health or the fetus's viability only magnifies whatever problem exists. In addition, the reason a woman is in a high-risk category typically lends its own physical challenge to the expectant mother's body. Thus, massage therapy can be even more therapeutic for high-risk pregnancies.
Seven reasons massage helps during pregnancy include its ability to:
1. Reduce stress, encourage healthful sleep and promote relaxation - especially needed during a high-risk pregnancy
2. Provide emotional support and physical nurturing - especially for those alone during their pregnancy or who feel scared because of their risk status
3. Reduces or alleviates neck, back and joint pain caused by posture, muscle weakness, tension, extra weight or imbalance - especially needed in women over age 35, who are obese or who are carrying multiple fetuses
4. Relieves muscle spasms, cramps and fibrosis - all of which can be intensified by several pregnancy risk factors
5. Via relaxation, reduces blood pressure - especially valuable to a woman with pre-eclampsia
6. Increase blood and lymph circulation which minimizes the edema, varicose veins and leg cramps common with pregnancy and exacerbated in many high-risk pregnancies
7. Encourage deeper and easier breathing - especially important for women with asthma or lung problems
Caution or Contraindication?
Because complications, illness or death are more likely to occur in a high-risk pregnancy, any healthcare provider must proceed with caution and vigilance. For the safety of the client and the massage practitioner, any high-risk pregnancy necessitates communication with the woman's prenatal healthcare provider and a signed release form. This release form should contain at least two components:
1. Confirmation that the prenatal healthcare provider (physician, ob-gyn or midwife) approves massage therapy
2. A listing of any precautions or limitations of massage procedures
When working with a high-risk pregnant client, observing basic precautions and contraindications for bodywork in pregnancy is crucial. Restrictions and considerations for pregnant clients may include:
· Positioning for a Massage Session - the side lying position is often advised for pregnant women.
· Modifications for Bodywork on the Lower Extremities - Because blood clots are more likely to develop during pregnancy, deep pressure or friction should be avoided on the legs. In addition, all leg techniques should go in the direction of the heart since hormonal changes in pregnancy weaken the vein's valves.
· Abdominal Massage - Since 80 percent of miscarriages occur in the first trimester, abdominal massage should be completely avoided during that time span. In addition, therapists are advised to minimize abdominal massage to high-risk pregnancy clients even in their second and third trimesters.
· Acupressure Points - With high-risk clients, it is even more crucial to avoid the acupressure points contraindicated in pregnancy.
· Heart Condition - In general, massage therapy techniques that encourage circulation should be avoided in the third trimester for clients with a heart condition.
Despite a therapist's best efforts, there are several situations where even a cautious approach and a signed release form are insufficient. In addition to massage therapy being contraindicated, an immediate healthcare referral is mandated for:
· Possible Miscarriage - Signs include a bloody discharge, continual abdominal pains and sudden gush of water or leakage of amniotic fluid
· Urinary Tract Infection - Signs include frequent urination with burning, low back pain, increase in thirst, chills and fever
· Eclampsia (Toxemia) - This is an emergency situation! Developing in 1 out of 200 patients with pre-eclampsia, symptoms include persistent severe headaches, persistent severe back pain unrelieved by change of position, severe nausea/vomiting, systemic edema, pitted edema, increased blood pressure, visual disturbances and convulsions
If massage therapists don't allow the possible dangers of a high-risk pregnancy to frighten them, working with this population fulfills an enormous need for specialized prenatal care. By communicating with prenatal care providers, obtaining signed release forms and being aware of the difference between massage cautions and contraindications, bodyworkers can be a tremendous ally to expecting mothers - especially to those who need it most.