Prenatal massage is a commonly recommended therapy for stress, swelling, and pain during pregnancy. However, its overall safety, possible effects to the fetus, initiation of labor, or potential changes in circulation/blood flow that may affect the fetus have not been studied; further, current published studies have only been conducted by a handful of researchers.
Massage therapy is the manipulation of soft tissues all over the body to increase circulation, assist in waste removal through the lymphatic system, relieve sore muscles, and improve general well-being.
Sessions can last anywhere from 15 to 90 minutes, and involves a licensed massage therapist using oils or lotions to conduct various strokes on the body.
*Note: In most states, there is no legal requirement to obtain separate training or certification in prenatal massage and there is no national or state level certification/standard. Certified Prenatal Massage Therapists get this certification through Continued Education courses offered through different privately held massage institutes.
In research that has been published regarding massage and pregnancy, women reported decreased anxiety and depressive symptoms (including postpartum), better sleep, and reduced leg and back pain, to include when massaged by their partners for only 20 minutes a day/twice weekly.
An indirect benefit of massage during pregnancy may include decreased cortisol (stress) levels in the newborn as well.
In a study of labor pain, women who received massage therapy from their partners for the first 15 minutes of every hour experienced significantly less pain, and their labors were on average 3 hours shorter (all stages) with less need for medication.
Further, a separate study indicated that massage from a registered therapist during labor may be an effective form of pain management that could lead to delayed used of an epidural.
It is theorized that massage can lead to the above beneficial effects through the following means:
Gate theory: pressure messages travel more rapidly than pain messages, reaching the brain faster and closing the gate to the pain message.
Vagal activity: vagal activity increases immediately after massage therapy sessions and across repeated sessions of massage therapy, leading to decreased heart rate and better sense of calm.
Endorphins: “Endogenous morphine”; massage stimulates the release of endorphins, which naturally block the perception of pain.
Although rarely studied during pregnancy, there is currently no evidence first trimester prenatal massage can lead to miscarriage. The biggest concern regarding the possibility of miscarriage is that first trimester massage could theoretically decrease blood flow away from the embryo, thereby decreasing oxygen and other nutrients to the embryo.
However, even if this occurs, which again, has not been studied, this would be highly dependent on the length and type of massage (i.e. a foot massage is unlikely to have this type of effect). Further, although the mechanisms could be different, sufficient blood flow away from the embryo to cause adverse effects has not been determined to occur even during first trimester exercise.
There are relatively few general contraindications to massage, but side effects may include muscle soreness from too vigorous of a massage, or possible allergic reactions to lotions or oils used. It is also possible that massage may decrease blood pressure enough to temporarily lead to dizziness or exacerbate nausea.
Of note, the American Massage Therapists Association indicates that therapists should avoid massaging women who have been diagnosed with a blood clot. They also indicate massage over varicose veins should be avoided in the event a blood clot may be present. Further, women with preeclampsia or placental problems may require an HCPs permission for a prenatal massage.
Additionally, prenatal massage, depending on stage of pregnancy, requires a specifically designed table meant to allow a woman to relax restfully on her side, not her back or abdomen. During the massage, pregnant women will move side to side, rather than back to stomach. The hips may also be propped up to make the woman more comfortable.
There is little to no safety data on prenatal massage during pregnancy, especially during the first trimester. Further, although many possible benefits during pregnancy have been noted in published studies without resulting in adverse effects, these studies were small, and length and style of massage was either limited or relatively informal (partner vs. professional).
Pregnant women who wish to get a massage should talk to their HCP first, and make sure their therapist has additional training in prenatal massage. Women should also be aware that most massage therapy locations will not accept pregnant women until the second trimester, as a precaution.