10 Pregnancy Massage Mythconceptions

By Sharon Livingstone

“Sometimes massage therapists, when confronted with the lack of evidence to support this idea, will respond, “Well, I’ll avoid it just to be careful.” One should always err on the side of caution when in doubt, but that does not mean we have to be governed by false fears. By erroneously thinking they need to avoid the feet and ankles “just in case”, massage therapists perpetuate this misconception.”

Alice Sanvito, Massage Therapist, Massage St Louis

Did you know that 64% of people who received massage and other CAM treatments prior to pregnancy continued to have treatment during pregnancy?(1)

When a pregnant person books in to have a massage, they actually want a massage. No pregnant person wants to be refused treatment based on misinformation, false information and unsubstantiated myths.

So Where Do The Myths Come From?

Pregnancy massage myths aren’t only spread by massage therapists. They’re prevalent in massage schools, beauty schools, online forums for pregnant people, and even trip up many GPs.

Leslie Stager, author of Nurturing Massage for Pregnancy, wrote an article for ABMP about pregnancy massage misinformation which discusses where the myths originated. Stager discovered that during the 1900s, when midwives and home birthing were being replaced by a medical model of care, “Pregnancy was identified as a dangerous and fragile condition with many forms of activity viewed as potential adversaries to a healthy outcome”.

Although there was a shift back to the home-style and less intimidating birthing methods during the 1970s and 80s, for some unknown reason massage therapists remained in the “pregnancy is a dangerous and fragile condition” camp. We were still being taught that the slightest touch would damage a pregnant person and/or their baby.

During the 1990s, evidence of the benefits of prenatal massage was growing. According to Stager:

“Research indicated that massage could help decrease stress and the production of catecholamines (stress-related hormones), improve hormonal functions, speed labor, reduce pain from contractions, and increase the frequency and ease with which a mother touched her new infant, benefits known to traditional birth attendants long ago.”

The Myths of Pregnancy Massage

1. Massage causes miscarriage

This myth underlies most of the other pregnancy massage myths and ignores commonsense. Miscarriage has many causes but massage is not one of them.

Medline Plus lists causes and prevention of miscarriage on their website. Massage is not listed.

In her article on Clearing Up Misconceptions About Pregnancy and Massage, Alice Sanvito from Massage St Louis wrote:

For most miscarriages, the cause is unknown, but some known causes are chromosomal defects, failure of the fertilized egg to implant properly, maternal age, or excessive use of drugs or alcohol. Moderate exercise, sex, and working outside of the home do not cause miscarriage. If normal activity is not sufficient to cause miscarriage, there is no reason to believe that a relaxing massage would in any way cause it, either.

There is no evidence to suggest that massage causes miscarriage.

Miscarriage has its own set of myths. The “Further Reading” section at the bottom of this article includes some useful information on miscarriage.

One of the most common reasons I’ve heard from Massage Therapists for not treating pregnant people is a fear of litigation. If miscarriage occurs after a pregnant person receives massage, there appears to be a belief that the Massage Therapist will be sued. Stager failed to find any evidence of a successful lawsuit. Equally, I found no information on a massage therapist being sued (successfully or unsuccessfully) for causing a miscarriage.

2. Massage is contraindicated in the first trimester

This myth seems to arise out of the first myth and may be connected to the fact that miscarriage most commonly (in 80% of miscarriages) occurs within the first trimester.(2)

Most massage therapists have probably massaged a pregnant person in their first trimester without realising it because the client may not have known they were pregnant.

There is no research-based or clinical reason for not touching a pregnant person during the first trimester.

3. Don’t massage during entire pregnancy

This myth is generally grown from fear and may derive from the outdated belief that pregnancy turns a pregnant person into something fragile, where even the slightest touch will cause unknown but horrific outcomes.

Unless a known contraindication is present, such as those listed under “Contraindications for massage during pregnancy” below, there is no evidence to support avoiding treatment.

4. Don’t massage over the abdomen

Does this look like a dangerous and not recommended activity?

If it’s OK for the pregnant person (or their partner) to rub a pregnant abdomen, then why not a massage therapist? Bub may kick back if it doesn’t like it (or if it does).

The history of pregnancy is happily littered with supportive partners providing a nice abdomen rub, without the impediment of knowing about all those massage myths.

Commonsense test: Ask a pregnant person with kids how often their kids kick, hit, sit on or cuddle that pregnant belly.

5. Don’t massage over the lumbar region

This myth is sometimes restricted to the first trimester, most likely due to the unproven link to miscarriage. Please refer to “massage does not cause miscarriage” above.

Commonsense test: A pregnant person with low back pain will rub their own back with no fear of harming their baby, so why would a qualified Massage Therapist cause harm?

6. You must have specific pregnancy massage qualifications to treat pregnant people

Massage Therapists are trained to treat clients with a variety of presentations. They don’t undertake specialist training before treating a client who has fibromyalgia or Crohn’s Disease or Multiple Sclerosis or who is recovering from surgery. Massage Therapists can obviously undertake further study on treating pregnant people, particularly if they would like to specialise in this area, but it is not mandatory or a prerequisite for performing massage on a pregnant person.

7. You must have clearance from the treating medical practitioner before treating pregnant people

The GP, OB/GYN or other treating specialist may have reasons to advise their patient not to have massage and, in that scenario, Massage Therapists should defer to the treating doctor. However, unless there is a contraindication such as those listed below, there’s no requirement to get clearance from the treating medical practitioner. Any potential issues should come to light through a thorough pre-treatment intake.

8. Massage of the feet and ankles causes miscarriage and/or pre-term labour

There is no evidence that massage of the feet and/or ankles causes any detrimental impact on the pregnant person.

Alice Sanvito’s article discusses the reasons behind this myth, and suggests that the information comes from foot reflexologists and acupuncture practitioners.

“… when researchers have tried to use acupuncture on these points to induce labor in women past their due date, they have failed.”

Force into the ankle has as much chance of inducing labour in Achilles as a pregnant person.

A study undertaken by Neri et al (2014) supports this statement, as does this 2017 Cochrane review on reduction of Caesarean rates in post-date pregnancy.

If an acupuncture needle can’t find an alleged specific point to induce labour, then how can a Massage Therapist? If acupuncture can’t induce labour post-date, then why would massage result in pre-term labour or miscarriage?

Commonsense test: Are partners (and kids) of pregnant people who rub the pregnant person’s tired feet causing harm? What about shoes and walking – do they induce labour?

9. You need to pay extra professional indemnity insurance to treat pregnant women

Any insurer that tries to extract extra money from a Massage Therapist for performing massage on a pregnant person needs to be dumped and/or given a stern talking to.

Massage is a low risk activity, that’s why our insurance premiums are so low.

10. Don’t treat with the pregnant person in the prone position

While pregnant people are told not to lie supine because it may compress the inferior vena cava and potentially harm the mother and starve the baby of oxygen, there is no evidence to support the myth that women can’t be massaged while prone and supported by the use of bolsters, pillows, pregnancy cushions or a special treatment table, as long as the client is comfortable and remains comfortable.

Contraindications for Massage During Pregnancy

There are some instances where massage is contraindicated, including:

-Specific advice from treating medical professional.

-Placenta Previa (but not in all cases)

-Some high risk pregnancies (OB/GYN will advise):

  • Preeclampsia
  • High blood pressure/PIH (Pregnancy Induced Hypertension)
  • Previous pre-term labour
  • Recent bleeding
  • Pre-term contractions
  • Sudden severe headache.
Still Not Convinced?

Try this quick exercise. Go to PubMed and enter this search string:

massage + miscarriage

Please write a quick overview of the search results in the comments section at the end of this post.

If you thought that was fun, try the search string:

massage + first trimester + adverse effects

Further reading/watching

Newborns of depressed mothers who received moderate versus light pressure massage during pregnancy. T. Field et al

Antenatal maternal anxiety and stress related to foetal development

Pelvic Physical Therapist Sarah Haag’s Pregnancy and Pain talk at the San Diego Pain Summit in February 2018 ($US19.99)

Kristen Fischer “Dispelling Miscarriage Myths So Women Get the Help They Need

Diagnosis and management of first trimester miscarriage BMJ 2013;346:f3676

References

(1) Jane Frawley et al (2016) Complementary and alternative medicine practitioner use prior to pregnancy predicts use during pregnancy, Women & Health, 56:8, 926-939

(2) Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE, Armstrong EG, Nisula BC. “Incidence of early loss of pregnancy.” N Engl J Med. 1988 Jul 28;319(4):189-94

About the Author

Sharon Livingstone is a massage therapist in Sydney, NSW. A love of sport drew her to the industry but discovering job satisfaction came from helping people live with less pain keeps her in it. Sharon is a writer, keen bushwalker and frustrated traveller, who no longer daydreams of walking across France again because she’s booked her trip.

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Comments

  1. Karenlee Thompson
    05/04/2018 - 9:21 am

    Terrific article Sharon! Is it acceptable to print it and hand to a client (full referencing of course)

    • Sharon Livingstone
      05/04/2018 - 9:42 am

      Thanks so much for reading Karenlee. You can share the article (with a link) with your clients via your social media or email. I’ll also email you a PDF version for your clinic.

  2. Karenlee Thompson
    05/04/2018 - 11:48 am

    Thanks!

  3. Thanks so much! And I must admit to falling for the “first trimester” one. Nice to see someone busting a superstition!
    john

  4. Thank you so so much for clarifying. I am one that has listened too, quite often my peers and without questioning. Hense passing on the wrong information. This is excellent information, again thank you.

  5. Gerhard Hassler
    06/04/2018 - 8:07 pm

    Great article Sharon !
    Very helpful.
    Thank you for sharing 🙂

  6. Thank you for such great information.

  7. David Martin
    09/04/2018 - 7:48 am

    Hi Sharon,

    Brilliant article and fellow therapists that have done a pregnancy course advised me against treating a pregnant client. I will no longer live in the myth. Would it be possible to get a PDF of your article as well to have in my clinic please?

  8. Many of my clients prefer pressure that goes beyond what you describe. Since that creates a different sensation and perhaps different effects, is pressure a consideration?

    • Sharon Livingstone
      10/04/2018 - 9:50 am

      Hi Cath, Our article discusses 10 of the most common myths associated with pregnancy massage, and has no instruction on how to perform a pregnancy massage treatment, so I’m not quite sure what you’re referring to.

      • For example, more pressure than a pregnant women could apply on her own back (myth #5).

        • Sharon Livingstone
          10/04/2018 - 1:17 pm

          Hi Cath, thanks for clarifying. The test isn’t around the amount of pressure applied, it’s what harm can be caused by treating the lumbar region. There is no evidence that massage causes miscarriage. It’s important to remember that the pregnant person on our treatment table is not fragile and that the foetus is well protected. For a massage therapist to harm the foetus during a massage treatment would require a force resembling a serious physical assault.

  9. This is an awesome article! Thank you! ‘Commonsense test’ ????
    I have a presentation for my students on how massage is beneficial to expectant mothers based on my Filipino Culture’s (age-old) practices…too many fear-based contraindication articles around.

    I would like to ask if you are agreeable for me to share this article in print with my students? Full credit & reference to the Author shall be included.

    • Sharon Livingstone
      16/04/2018 - 12:51 pm

      Hi Lorelie, I’ll email you the PDF version but feel free to share the links to the article too 🙂 Sharon

  10. Thanks Sharon ! Great article. Putting our clients mind at ease when performing pregnancy massage is so valuable. Can you please send me the pdf of this for my clinic? Thanks in advance.

    • Sharon Livingstone
      16/04/2018 - 12:57 pm

      Hi Dean. Thanks for reading. Check your email inbox 🙂 Sharon

  11. Timothy E. Marable, AOS, BCMT, ACMT
    18/04/2018 - 2:12 pm

    Hi Sharon. It has been some time since I commented on this matter.
    Your article has given me fresh perspective on massage therapy for an expectant mother.
    Only recently was I asked by a fellow massage therapist/ client if she and her husband were successful in their attemps to become pregnant would I do pregnancy massage.
    Your article assures me that I should absolutely continue as her MT.
    In the past I felt it necessity to have established that relationship prior to pregnancy. Now I see with fresh eye.
    Thank you so much for posting.

    • Sharon Livingstone
      18/04/2018 - 2:23 pm

      So lovely to see your name pop up in these comments, Timothy. I do remember you making the comment previously that you would only work on an existing client who became pregnant rather than a new client. I’m so pleased that you have the confidence to change that position. I foresee many happy clients.
      Yours in massage,
      Sharon

  12. Dave T. RN LMT
    26/04/2018 - 6:35 am

    Magnificent! Shine some light on spooky myths. When questioned, I ask “How did the human race survive, before pregnant women were discovered to be fragile as flowers?” Anyone familiar with the physiological changes in pregnancy will agree that mothers are being remodeled to give birth! Any appropriate care-giving is in order. I have to curb my enthusiasm over the privilege of helping an unborn child and the mother. This should be a crusade! (Also postpartum massages) And since you previously invited, I will indeed share this!
    Thank you, Thank you.
    Dave

    • Sharon Livingstone
      01/05/2018 - 1:30 pm

      Thanks for reading Dave. And thank you for sharing the article.

  13. Thank you! I’ve been sharing with my team of therapists that not only is massage not contraindicated (most of the time) during massage, but is actually good for both mother and baby. Thanks for the great article!

    • Sharon Livingstone
      01/05/2018 - 1:30 pm

      Thanks for reading Joanne and thank you also for helping to spread the message to other practitioners.

  14. Victoria Jones
    02/05/2018 - 11:25 am

    Hi Sharon,

    Scarily, some of these myths were exactly what I was lead to believe during my recent training – so i’m very glad to read your article & references and now have more confidence that massage will be possible, even highly recommended, for pregnant ladies! As many others have asked, please could I have a PDF copy? TIA, Victoria

  15. Hi Sharon, Just re-read this article and would like to say thanks also for clarifying a lot of myths. May I too please get a copy of this in PDF form. Thanks. Gary

    • Sharon Livingstone
      27/06/2018 - 9:44 am

      Hi Gary, Thanks for reading and re-reading. I’m no longer providing the PDF version of the article for use as a handout because it’s aimed at MTs not clients and includes information that isn’t relevant to clients (such as our insurance). We encourage Massage Therapists to create their own handouts for clients, using the information provided.

  16. Jennifer Hanlan
    27/06/2018 - 9:16 am

    Thanks Sharon. I have been researching “Pregnancy massage” as I am providing training to students. When I completed my Diploma most of those myths came up especially 1st trimester one. I would love to receive the PDF copy.
    Jenny

    • Sharon Livingstone
      27/06/2018 - 9:45 am

      Thanks for reading, Jennifer. I’m no longer providing the PDF version of the article for use as a handout because it’s aimed at MTs not clients and includes information that isn’t relevant to clients (such as our insurance). We encourage Massage Therapists to create their own handouts for clients, using the information provided.

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