Pregnant woman having massage, elevated view

When your massage client announces her pregnancy, she may not yet display any external signs of the changes taking place within her body. However, in a matter of weeks, as her fetus grows, you’ll certainly notice her altered shape, which requires some modification when it comes to positioning. You still want to provide a relaxing experience for your client, but you also want to ensure she and her fetus are safe throughout the massage.

A general rule of thumb is to have your client switch from a prone or supine position to a side-lying position after 13 weeks gestation. Lying prone on a traditional flat massage table could place undue stress on the lumbar, pelvic and uterine structures, according to Carole Osborne, author of Pre- and Perinatal Massage Therapy. In her book, she explains lying face down can shorten posterior musculature and also compress and displace the lumbar vertebra and lumbosacral junction. This position may exacerbate any back discomfort your client is having. Lying prone also rotates the sacroiliac joints and puts additional pressure on the sacrouterine ligaments.

Moreover, as your client’s pregnancy advances, her breasts become enlarged; a facedown position on the table places undue pressure on her chest. Some women also tend to become congested when in a prone position, and the face cradle may exacerbate sinus pressure during pregnancy.

A supine position carries its own risks. Lying face up forces the uterus to sit on the inferior vena cava. Compressing this area for an extended period of time may cause low blood pressure in your client and negatively impact fetal circulation.

According to Osborne, physicians and midwives recommend left side-lying positioning to minimize risk to the mother and offer maximum safety for both mother and baby. While lying on either the right or left is advised, the latter optimizes maternal cardiac functioning and oxygen delivery to the fetus. This position reduces intrauterine and sinus pressure and also fosters somato-emotional integration.

Osborne points out that to ensure maximum comfort and safety, keep your client’s head in good cervical alignment using appropriate pillows or cushions. A small foam wedge or 8-inch square pillow, 2 to 4 inches thick, tucked under your client’s abdomen near the pubic bone will support the uterus, preventing strain to the uterine ligament and lumbar area. Osborne also recommends placing a similar size pillow under your client’s waist for lumbar support if her hip and waist proportions are significantly different. Another pillow under the upper arm will support the breasts and prevent anterior torso rotation.

You should extend your client’s legs and place the bottom one behind the top one so blood flow is not restricted. Place a pillow between the hip, knee and ankle so all joints are on a horizontal plane and to keep the hip and knee in slight flexion.

Not only does a side-lying position provide optimal physical comfort and safety, it may also offer some psychological benefits for your client. With the hormonal shifts that come with pregnancy, she may be more emotional than usual; this position induces a feeling of well-being, making your client more apt to express her emotions, both positive and negative.

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