Jolei Blanc Parrott
Pregnancy Massage | Massage Therapy Journal
Pregnancy Massage Learn what to expect when working with pregnant women, including the demands of working with women in labor and how to market maternity massage.
August 15, 2011
The more we start to understand about the benefits of massage therapy, the more opportunity opens up for massage therapy professionals—in a wide variety of environments. When thinking about where you’d like to practice, having as much information about the options available can help you choose a work environment, or environments, that fit both your personal and professional goals. In the following, you’ll find information ranging from what you can expect when working with pregnant women to the demands of working with women in labor to how you can market maternity massage. In this snapshot, you’ll get an inside look at working with this demographic so you can make informed decisions about where you want to take your massage therapy career. What You Need to Know Education. Though not legally required in most areas, getting advanced training in pregnancy massage is highly recommended. “Most massage therapists who want to specialize in this work very quickly find their marketing is much easier if they are thoroughly educated,” suggests Carole Osborne, author of Pre- and Perinatal Massage Therapy, now in its second edition. “A woman’s body goes through many, many adaptations during pregnancy on every body level, not to mention their emotions. These changes have significant ramifications for how we can most safely and effectively support these clients.” For example, though advising a massage client on medications and medical procedures is clearly outside the scope of practice for massage therapists, staying current on options is necessary. “Medical recommendations for pregnancy can and do change, and are relevant in that we need to know what the client is experiencing, as well as the treatments or tests done prenatally,” Osborne explains. “If a client comes in and tells you they had their non-stress test today, you want to know what they’re talking about. Usually this is performed when a complication or high-risk situation occurs.” Anne Heckheimer, owner of Prenatal Massage Center of Manhattan in New York City, agrees. “I sought out continuing education courses taught by leading educators in the field,” she explains. “Learning about the physiology of pregnant women and what they experience throughout their pregnancy, the special adaptive positioning for their massage and the pressure points contraindicated during pregnancy are just a few of the things that are covered in detail in advanced training courses for this special population.” This same sentiment is echoed by Ellen Brady, owner of Mother Earth Day Spa in Plantation Resort, South Carolina, and a massage therapy instructor at Miller- Motte Technical College. “I think everyone who wants to concentrate on pregnancy and postpartum massage benefits from taking advanced training courses,” she says. “They’ll learn indications and contraindications specific to pregnancy massage, along with positioning and techniques designed to alleviate some of the discomforts that can accompany pregnancy.” Heckheimer likens seeking out a massage therapist with additional training to a woman seeking out an obstetrician. “You wouldn’t want to go to your general practitioner to monitor your pregnancy,” she says, “so why wouldn’t you seek out a massage therapist who specializes in working with expectant mothers?” Ethics. You understand the ethical considerations that come with being a massage therapist, but you need to be prepared for situations that might be challenging when working with this client demographic. Osborne explains that many women look for community during pregnancy, seeking out support. Particularly for massage therapists who specialize in working with pregnant women, the lines might blur because you have additional knowledge about pregnancy. “Sometimes they think, ‘Here’s someone I can finally talk to about some things I want to talk about, like should I get an epidural? Is a midwife or a doctor better?’” she says. “There are going to be all sorts of things that are outside your scope of practice you’re going to have to negotiate your way around.” Other ethical considerations surrounding personal and emotional boundaries might also come up when working with this demographic. For example, you might have a client who comes in with back pain and you schedule an hour but spend 90 minutes in the session, or you have a client who is on bed rest, so you travel to her home. “It’s sometimes easy to lose track of issues of time and payment,” Osborne says. Related: Creating Healthy Boundaries | 3 CE Credits Additionally, if you work with women during the labor process, there are boundaries that you necessarily can’t maintain. “Maintaining proper draping often isn’t possible during a woman’s labor,” Osborne explains, “so you’re going to have to find ways to interact with the client and keep some boundaries.” The same goes for reestablishing professional boundaries after you’ve worked with a woman so intimately. For example, Osborne has had clients who begin undressing while she’s still in the treatment room after she’s been through their labor with them, and so she has to remind them once again of the professional boundaries surrounding their postpartum work together. Positioning. When working with pregnant women, positioning becomes critical. “Pregnancy massage is specific to the needs of each client,” says Heckheimer. “Therapists must be extremely comfortable with the positioning of pregnant women and proficient in their massage technique in either side-lying or sometimes prone position with cushions.” Positioning is going to differ, too, depending on where the woman is in her pregnancy. “By the second trimester, all massage should be done with the mom in a side-lying position to keep pressure off the vena cava,” suggests Brady. “Also, much of the massage can be done with the mom lying on her left side to support venous return.” To provide adequate support, massage therapists should seriously consider investing in a body support system designed for pregnancy massage, Brady suggests. Related: The Benefits of Using Side-Lying Positioning | Massage Therapy Journal Positioning for pregnancy massage also has implications for you as a massage therapist. If you aren’t familiar with proper body mechanics for side-lying positions, for example, your neck and back may pay the price. “Body mechanics as a massage therapist change with side-lying positions,” Osborne explains. “If a massage therapist hasn’t received some guidance, adapting can be physically difficult.” PRO TIP: "One of the key differences between prenatal and postpartum massage therapy is the positioning. As a prenatal massage therapist, you have to learn to position your clients with pillows, cushions and bolsters so that your clients will be extremely comfortable." —Anne Heckheimer Marketing Yourself Promoting your practice. From the beginning of her career as a fitness trainer, Heckheimer gravitated toward working with pregnant and postpartum women. “Working as a prenatal massage therapist was a natural progression to my career and complemented the work I did in the gym with my clients,” she explains. For Heckheimer, and many others, marketing is one of the biggest challenges of opening and maintaining a prenatal and postpartum massage therapy practice. For one, working exclusively with this population means that Heckheimer can’t count on regular clients, and so must continually market her practice. “Moms-to-be usually see me once-a-week for the term of their pregnancies, and maybe a few times postpartum,” she explains. “Then, they disappear until their next pregnancy.” Related: Marketing Resources for Massage Therapists But this challenge doesn’t get in the way of Heckheimer’s success. “I have a highly optimized website that has helped me grow my business,” she says. From the homepage, Heckheimer has clear links that direct visitors to important information, ranging from the benefits of massage during pregnancy to frequently asked questions to her biographical information. “I also circulate my brochures to ob-gyn’s offices several times a year,” Heckheimer adds. “I’ve formed partnerships with other professionals like chiropractors and physical therapists, and we cross-refer to one another.” Networking. There’s also a great deal of opportunity for you to connect with other health care professionals, and you might find that maternity massage is one area where you’re more readily accepted within medical practices. “Massage therapists can make appropriate contact with a client’s health care provider,” explains Osborne. “They can inform the physician that they’re seeing their patient and invite them to communicate if they have any questions or concerns.” Of course, you should seek permission from the client before reaching out, and be sure you’re abiding by all of the privacy standards outlined in HIPPA regulations. These relationships can be successful in helping other health care professionals better understand the benefits you can offer, and although they may take some time to establish, you can end up being the provider of choice for a hospital, for example. “When you can, introduce yourself and your services to the client’s doctor,” Osborne encourages. “You might say something like, ‘I’ve recently begun working with one of your patients and she thought you might be interested in my services.’” Related: Communicating + Collaborating With Health Care Professionals Client enthusiasm can also help build relationships with other health care providers. Osborne knows a massage therapist whose client raved about her experience with her to her obstetrician, prompting the obstetrician to ask some questions and refer more of her patients. “Other ob-gyns in the same office started to send patients, and then they asked if she’d want to set up times to actually come into the office,” Osborne says. PRO TIP: Massage therapists who find they’re really interested in working with this demographic specifically—and want to participate in the labor process—might consider taking their training one step further and becoming a doula. “You’ll learn things in doula training that you wouldn’t learn as a massage therapist. But as a massage therapist, you’ll have a wider range of touch techniques available to you.The doulas that I know that are also massage therapists do very well."—Carole Osborne Demonstrate. As you start making connections with other health care professionals, try to find ways you can showcase massage therapy to pregnant women. For example, Osborne suggests massage therapists might be able to do a segment during a childbirth education class, demonstrating techniques that a partner can use to help. “Sometimes you might find an ob-gyn who is open to a massage therapist coming to the waiting room and offering chair massage,” she adds. That’s exactly what Brady does to promote her practice. “Offering to present a short talk about pregnancy massage to a childbirth class, an ob gyn practice or a prenatal yoga class can be helpful,” she explains. “I also had special business cards made featuring the massage of a pregnant woman, and I make sure they are always in my pocket.” Brady also suggests sending a press release about your practice to your local newspaper, or consider writing an article on the benefits of massage therapy during pregnancy. What's Expected of You Negotiating complexity. Osborne believes that one of the greatest things about maternity massage is its complexity, but that also means there are many expectations of a massage therapist on many different levels. “It asks a tremendous amount on a physical, emotional and intellectual level,” Osborne explains. “Everyone of us has an emotional reaction to working with pregnant women, so there’s a lot of emotional attention you need to pay to yourself, as well as what the woman is experiencing on an emotional level.” That means you have to be clear about being able to stay present with someone, truly be in a state of compassion without taking on someone’s concerns. “Maternity massage also demands a good intellect so you can understand what’s going on with a woman physiologically,” Osborne added. So, take some time to really think about your professional goals and how maternity massage fits into your vision. “Some massage therapists find the work too daunting,” Osborne says. “Others find the demand of this and the way in which it engages us on many levels a tremendous joy.” Self-reflection. There’s no question that working with pregnant women can be emotional, and massage therapists looking to do this work need to be prepared to take care of themselves, both before deciding to perform maternity massage and periodically throughout their career. “I think one of the things that therapists need to do when specializing in this work is to spend some time in self-reflection, possibly counseling,” says Osborne. “They need to sort through whatever their emotional baggage is related to pregnancy, in whatever ways work for them.” Taking some time to reflect isn’t limited to only women who work with this specific demographic, though Osborne does suggest that women especially need to deal with their own experiences surrounding pregnancy. Both male and female massage therapists working with women in labor, particularly, are going to have to deal with outcomes that can be both joyous and traumatizing. “I’ve gone to labors where progress or outcome of labor has been such that I needed the help of a practice supervisor to sort my way through my emotional reactions to what occurred,” Osborne remembers. “You can’t help but sometimes wonder about what you did and didn’t do, or perhaps have questions about what happened with the medical team.” In order to continue to remain focused and ensure you are providing yourself enough emotional self-care, having someone to talk with, whether a mentor in the massage therapy profession or outside professional, is going to be key in this work. Schedule. One glaring exception to keeping a regular schedule in maternity massage is if you decide to work with women during labor. During this time, you might be called after normal business hours, and the work might involve being with the client for many hours, maybe a day or more. Osborne recommends that massage therapists seriously consider this aspect of the work when making decisions, and be especially honest with yourself about how you’ll handle the demand. “You need to carefully consider whether the demands of labor can be successfully incorporated into your personal and professional life,” she encourages. Although there aren’t any unusual physical demands for working with pregnant women, working with women during the labor process can be very physically demanding. “You can end up walking with a woman and essentially holding her up while you’re massaging her back,” explains Osborne. “For that, you need a tremendous amount of physical stamina.”