The pregnancy question finally answered

Pregnancy Massage is a treatment that I have always loved to offer, and it’s one of my favourite classes to teach because you really get an amazing view of how the body works, and all the fine detail of changes that take place whilst a baby is developing in the womb.

Sadly this sentiment isn’t always shared, and it became apparent when I was messaged by a Mum who I met during my pregnancy with Moxie, she was also pregnant at that time and we belonged to an online group for women who were due in the same month.

She reached out because she knew I was in the massage industry, and was worried about an upcoming Spa Day she had booked.

Having just found out she was 6 weeks pregnant, she was worried she would lose out on her booking.

I suggested that she contact the place she was due to visit, and let them know her situation so they can advise her on how they would like to continue.

If they have therapists on staff who are trained in Pregnancy Massage and she has no health concerns or contraindications for pregnancy massage, the treatment she was receiving shouldn’t have been an issue.

She called and they made a note of her condition, and she made the journey with her family for her Spa Day.

I got a call from her whilst she was there, and she was inconsolable. Long story short, they refused the massage which they are entitled to if they don’t feel comfortable with performing the treatment or are untrained, but they went on to treat her pretty poorly.

At one point during the facial portion of her package, she was visibly upset and told by the therapist that she “can’t see what the problem is, she’s pregnant after all, surely thats something to be happy about.”

It made me sad.

If this was a first time mum, I can’t image how upsetting this would have been, but it did make me decide that enough was enough.
I wanted answers. I wanted to know why the “No massage in the first trimester/first 13 weeks” rule is still being taught to students, and I wanted to know whether our Massage Associations and Insurers still adhered to this belief or whether they were updating policies as new research and findings are being released.

I started with writing a list of everyone I felt had an authoritative say in this issue, and I contacted each of the following:

Federation of Holistic Therapists (FHT)
Complementary Therapy Association (CThA)
Complementary and Natural Healthcare Council (CNHC)
The Guild of Beauty Therapists
Balens Insurance
Associated Beauty Therapists (ABT)

I also reached out to the Subject Matter Experts, and contacted Elaine Stillerman, author of Prenatal Massage and Carole Osborne, Author of Pre- and Perinatal Massage Therapy. Both books have been extremely invaluable in the development of our own Pregnancy and Post-Natal Massage course.

 

I am still waiting for a response from ABT and Carole Osborne, but understand they may be very busy and don’t expect an immediate response, however I will update whenever I do receive feedback from them.

The question I asked was very simple:

“Can you provide me with details on your organisations stance on Massage during the First Trimester, and (if you are an insurance company) do you provide coverage for therapists with adequate training on the subject?”

The first response I received was from The guild, and this is what their stance is:

Our policy stipulates – Treatments on pregnant clients
Our insurance policy wording has a warranty that applies to anyone who holds a specific Pregnancy Massage qualification and this must be adhered to be insured

1 PREGNANCY MASSAGE. the INSURED must
(i) have the client’s General Practitioner or Midwife’s consent prior to treatment
(ii) not massage over the abdomen
(iii) not carry out treatment during the first trimester (12 weeks)
(iv) not massage pressure points on both sides of the ankles nor massage the webbing between thumb and index finger

A little disappointing, strike one for an Insurer who won’t cover a therapist performing massage during this term. I am glad that they listed their policy wording, as it highlights their reasoning, and allows us to research further into the claims made above.

The rest of the responses came in pretty swiftly, and I am pleased to say that they were mostly positive in nature.

The FHT provided us with this brilliant response:

We have recently published some pregnancy guidelines for all our FHT members.

I have attached the link for you.

www.fht.org.uk/FHTguidelines/pregnancy

Which is a nicely comprehensive outlay of their thoughts on Massage in the first Trimester, as well as comments on the “danger zones” often mentioned in pregnancy massage discussions. At the end of the day, they recommend attending an in-depth training course on the subject so that you can learn about the physiological changes during pregnancy, as well as safe handling and treatment of a pregnant client.

Ideal!

The CThA followed with suggestions that the client receive permission from their GP or Midwife, and if that isn’t possible signing a waiver to state that they understand what’s involved with a pregnancy massage. I think this is great, and should definitely be going through this with our clients when they attend their first massage during pregnancy.

It is advised that  medical, GP or Specialist permission is obtained prior to treatment– In circumstances where written medical permission cannot be obtained the client must sign an informed consent stating that the treatment and its effects have been fully explained to them and confirm that they are willing to proceed without permission from their GP or Specialist

 

The CNHC unfortunately don’t have a specific clause relating to Pregnancy Massage and have suggested that Therapists contact their Insurers, or relative Associations for additional information. Having a regulatory body like CNHC is great, lets hope that as they build as an organisation, we will see the Massage group more refined as Pregnancy Massage is an area where standards would be very beneficial.

Balens Insurance also referred us to the guidelines laid out during our training and made no mention of an inability to be covered by your insurance policy.

Thank you for your message.  We recommend that our clients follow the guidelines of their training in relation to the treatment of pregnant patients.

 

So I’m very happy with the results, and hopefully this should highlight the fact that we really need to share this information with our fellow therapists, and show them that times are changing and we are becoming more informed in the benefits or effects of massage therapy, and shouldn’t be frightened by it.

To finish up I wanted to leave you with the wonderful response I received from Elaine Stillerman, detailing the details behind massage during the first trimester, and hope it makes you feel a bit more comfortable working with pregnant clients. However please remember that if Pregnant clients is a population that you are unfamiliar with, get in touch with us regarding our Pregnancy and Post-Natal courses, as we’d love to share theory and techniques with you that will blast away those fears.

When a massage practitioner is trained in the correct protocol for prenatal massage,  it is safe throughout the entire pregnancy. How many times have pregnant women failed to inform their practitioners about their pregnancies, and yet nothing unhealthy resulted?

But let’s look at this from an anatomical point of view to understand why this old wives’ tale still persists. There are two compelling factors at play here. The first is the fear of miscarriage. The false assumption is that since most miscarriages occur during the first few weeks of pregnancy, if you don’t massage, you won’t cause a miscarriage.

Most miscarriages do occur within the first 8 weeks of pregnancy, but they are not caused by anything the woman did or did not do. 50% of examined fetal cells indicated that the embryo was not viable. It could not sustain life (blighted ovum, failed mitosis, genetic anomalies, etc). Massage has absolutely nothing to do with that cause factor.

So let’s examine the remaining 50% of known causes for the loss of the pregnancy: anatomical or structural maternal obstructions; ectopic pregnancy; heightened maternal immunological response; hormonal imbalances; and environmental factors (smoking, drugs, toxicity, chemotherapy, etc.) No where is massage a factor.

Serious trauma to the pelvic cavity is another possible cause, but appropriate massage avoids deep pressure to the pelvic or abdominal cavities.

Furthermore, any client presenting symptoms of a miscarriage would never receive a massage from a trained professional. So we have dispelled that theory.

Secondly is nausea. Any client, woman, man, or child, presenting with nausea or vomiting should not receive a massage. 60- 90% of gravidas experience nausea, usually within the first trimester, although some don’t until later on. Massage is contraindicated when  any client has nausea. 0.3-1.2% suffer from hyperemesis gravidarum ( your own Kate Middleton) and should never receive a massage. But if the distress subsides by mid-day, then it is a safe to massage when the waves have passed. And I teach techniques to relieve the nausea.

Bottom line, it is a safe to massage during the first trimester when the practitioner is appropriately trained.