Pregnancy & Massage

I am newly qualified in pregnancy massage myself, so I am keen to hear views on this myself...

..... that the whole aspect of 'contraindications' is getting out of hand perhaps????

..... that the whole aspect of 'contraindications' is getting out of hand perhaps????

I fully agree, which is the point of my posting, but I would like to know how massage therapists usually approach this.

It seems to me therapists become increasingly "flexible" if they need to make a living at complementary therapy. It seems asking a client for a doctors written consent is pretty much like saying "go elsewhere", and verbal consent is only slightly easier.
I may be wrong but there does seem to be a gulf of difference between the training and best practice and the practical reality. Maybe I am wrong, I am keen to hear what others say, 2010 is my first year.

I've been a therapist since 1977, and have treated loads of pregnant women (and a pregnant horse - really - long story!!!).

Where's the problem/contraindication? As long as the woman is healthy there is NOTHING WRONG WITH HER - she is simply pregnant! Why some of the trainers/schools have started to warn newbies that you have to avoid the first trimester - what's that all about and what evidence to they have that massage causes problems?

Yes, anyone treating pregnant clients should check that everything is going OK and that there is no underlying stuff like gestational diabetes or pre-eclampsia, but usually the midwives are well in charge by then, and you are unlikely to see them, other than possibly for a bit of TLC.

The avoidance during the first trimester thing does make me cringe sometimes - from personal experience - I didn't know I was pregant with Number 1 daughter until I was about 16 weeks..... I can't begin to list the 'bad' things I did during that time - including massage and reflexology!!!

"Doctors permission"?? You are unlikely to get it, well, certainly round our way - the doctors will not respond to letters. I have two very good friends who happen to be GP's and they admit they never reply to therapists letters and when a patient asks if they can try (insert therapy here) they usually say 'why not - at least it may make you feel good - can you afford it?'....!

Hi Jabba,
I think the problem is that schools teach it as a contraindication because it has been stated in books on massage etc.

I have been looking at a whole host of massage contraindications, and think there are a huge amount that need updating. I think that with the wonders of medical science, the number of contraindications is reducing, and replaced precautions.

I think pregnancy as a contraindication needs to be dropped, and replaced with precaution, as you say make sure there are no underlying problems associated with the pregnancy, or the health of the client in general.

I generally go with the thought of anything after 3 months is ok. At least thats when a woman is most likely to miscarry if shes going to therefore less likely Id be blamed or feel that id been the cause

Paula
xxx

Hi ST

I'm with JTH on this one. I do about approx. 7 pregnancy massages per year and never had a problem at any stage of pregnancy. Pregnancy a natural state not a medical issue, unless there is a medical issue. Exam boards and tutors are just trying to protect the student from taken too much on if something goes wrong. Shame schools don't tell their students that with experience contraindications become indications for treatment. Pregnancy massage is a specialist field and I recommend that therapists would benefit from additional training. Working on mums-to-be is an ideal opportunately to show the benefits of massage, especially when so many women don't get pre-natal support.

Have you contacted various insurance companies to find out their attitude to massage therapists working with pregnancy clients? There are the ones that have to look at risk! Isn't 98% of miscarriages in the 1st trimester due to chromosomnal (sp) abnormalities?

Best Wishes

RP

Hi RP,
there is literally nil evidence that massage has any detrimental effects in pregnancy. Im hoping that we can get some changes made in massage contraindications, in fact, a complete overhaul.

I do pregnancy massage and follow the same rule as everyone else, in that pregnancy is something to be aware of but certainly not to stop treatments from taking place.

I have massaged many people at different stages of pregnancy, some from the day they have found out! I think its more about creating an honest and open relationship, so the client feels secure and you feel confident as the therapist.

I did do a pregnancy massage course am glad i did it, if only to be more confident on how to make my client comfortable etc.

I've been a therapist since 1977, and have treated loads of pregnant women (and a pregnant horse - really - long story!!!).

Where's the problem/contraindication? As long as the woman is healthy there is NOTHING WRONG WITH HER - she is simply pregnant! Why some of the trainers/schools have started to warn newbies that you have to avoid the first trimester - what's that all about and what evidence to they have that massage causes problems?

Yes, anyone treating pregnant clients should check that everything is going OK and that there is no underlying stuff like gestational diabetes or pre-eclampsia, but usually the midwives are well in charge by then, and you are unlikely to see them, other than possibly for a bit of TLC.

The avoidance during the first trimester thing does make me cringe sometimes - from personal experience - I didn't know I was pregant with Number 1 daughter until I was about 16 weeks..... I can't begin to list the 'bad' things I did during that time - including massage and reflexology!!!

"Doctors permission"?? You are unlikely to get it, well, certainly round our way - the doctors will not respond to letters. I have two very good friends who happen to be GP's and they admit they never reply to therapists letters and when a patient asks if they can try (insert therapy here) they usually say 'why not - at least it may make you feel good - can you afford it?'....!

I love reading your posts JTH they are so informative and inspiring. I am glad that sportstherapy posted this as this doesn't just cover Massage, but Reflexology and possibly Indian Head Massage and Aromatherapy ?

It was instilled into us at college never ever before the 1st trimester, never ever to practice Swedish Massage on someone with M.E/CFS etc etc, we would never have any work would we considering women are always going to have babies and some poor soul will have a debilitating illness, where will it end ??

I have to admit that I was working on pregnant clients before doing a specialist course. Like Andan says it is about the therapeutic relationship between therapist and client.

My pregnancy clients have often said to me that thank goodness that I wasn't afraid to give them a treatment as they have come across therapists that were too frightened. If I listened to contraindication lists instead of using my professional judgement, I would throw in the towel and give up.

The contraindications list is long isn't it, surely this is what a consultation form is for, I mean we're not stupid or........ lol

As holisticbabe says, most miscarriages (and there are more than most people think) occur in the first trimester. Some unfortunate women who experience this find it very traumatic and are desperate to find a cause. I don't think anyone really thinks a considerate massage is likely to trigger a miscarriage, even in the first trimester, but I think a therapist may feel awkward about having treated a pregnant woman a few days before she miscarries - and their insurance company would be very nervous indeed. The specialist course is mostly about discovering some sub-contraindications within pregnancy and about how to make the pregnant woman comfortable.
It is a shame we live in a blame culture otherwise massage in pregnancy would be much more widespread.

.......... but I think a therapist may feel awkward about having treated a pregnant woman a few days before she miscarries - and their insurance company would be very nervous indeed. The specialist course is mostly about discovering some sub-contraindications within pregnancy and about how to make the pregnant woman comfortable.
It is a shame we live in a blame culture otherwise massage in pregnancy would be much more widespread.

On the tricky subject of insurance - has anyone here had personal experience of litigation by a client - with respect to this particular topic? Or, do you know of a therapist who has been taken to court over this?

Hi JTH

I was told once of a reflexologist that was taken to court for a miscarriage issue (within the 1st Tri). It didn't go any further because the fact was brought up about of the high level of chromosomal abnormalities that can occur in the 1st trimester.

I can't remember whether I read that in a trade journal or in conversation with an insurance person.

Best Wishes

RP

I do about 7 pregnancy massages per WEEK most of the year.

All the no go acupuncture points and reflexology points, IMO, don't do a thing if all is going well. I have worked on enough people very close to due date where I have worked on all of those points and in my experience, it seems to accelerate things IF the body was progressing that way; about a third of people go into labour within 36hrs, the other two thirds generally go into labour after 5 or more days, ie the acupunture and reflexology points seem to speed up things for people that were going to go into labour in the next 4 or 5 days anyway, 5 or more days later, working on all the acupunture and reflexology points does nothing. BUT all the text books and training I have done say avoid those points, so I do, for legal reasons only.

As for the first trimester, miscarriages are very common in the first trimester. The general recommendation for people when they fall pregnant is in the first trimester don't change your routine - don't embark on a new exercise program, don't suddenly change your diet, and I add don't start getting massages if you don't normally have them. I will work on existing clients in the first trimester, if they get a regular treatment every month, they often don't know they are pregnant for one or two of those treatments anyway (I've been the first person to tell them they might be pregnant quite a few times, the difference in body temp around the lower back can be quite dramatic) and stopping their regular routine for one month is silly. I won't take on new clients during the first trimester, but saying that, I have never had anyone make an enquiry about getting a pregnancy massage earlier than week 10; at week 10 or so, it is very easy to tell people they need to wait until 2nd trimester. I usually get about 2 or 3 enquiries a year from people around week 10-11.

The two things I do get overly cautious about are aromatherapy oils and hot stones. My intake forms asks if someone is trying to become pregnant.
I avoid aromatherapy oils as much as possible all the way through the pregnancy. Essential oils are powerful natural chemicals, but they are still powerful chemicals. The everyday load of chemicals a mother to be has to deal with in modern life is huge already, so I avoid adding any other powerful chemicals to the body's chemical burden, natural or not. The chemical load in the amniotic sac is a big concern too.
Heat and pregnancy is also a no no, early on it can affect the development of the baby and later it can lead to the baby turning into less than optimal positions if applied poorly.

I'm glad I came across this post as I was about to ask advice on getting doctors/midwifes permission for a pregnancy massage. As my training had stated this is now a legal requirement. I asked a lady this week to check with her consultant to get written permission for the pg massage and was later called by my potentail client to say that the doctor laughed at her and said "we only write letters if you are flying" This said doctor also laughed and poo pooed this clients enquiry about rasberry leaf tea in the last few weeks of pg to bring on labour. doctor said..."thats not medical that homeopathic" I was discususted by this doctors general attitude and how they feel they have the heirarchy on appraches and methods of treating someones health, especially at a sensitive time like pregnancy.
So what I would like to know is should I bother asking my clients to seek permission or not and carry on with the usual practice of getting them to sign a disclaimer as a precaution. Am I waisting my time and potentially loosing clients who may be scared off by having to go to the bother of getting consent or who just forget to do it and never ring back.
thanks
Karen

Hi karen

To practice massage on a pregnant client need permission from GP/Midwife? First I heard about it, unless it is a Northern Irish law. Unless it is a legal requirement in NI, you don't need permission to treat a client. They (the client) is given you permission themselves to be treated.

You sure this legal requirement isn't just the exam boards / college over zealous application to protocol?

What I would do in your situation is to contact your insurance company and ask them if you are covered to practice on pregnancy clients and is there any restrictions, ie practicing within the 1st trimester.

best wishes

RP

Hi RP,
I think the law is involved at some point regarding healthcare etc. I will have a look and see, but I'm sure I read about it recently.

You sure this legal requirement isn't just the exam boards / college over zealous application to protocol?

What I would do in your situation is to contact your insurance company and ask them if you are covered to practice on pregnancy clients and is there any restrictions, ie practicing within the 1st trimester.

best wishes

RP

HI RP,

As part of my CPD in 2009 I did a one day practitioner course with Gateway workshops and it was stated very clearly in our manual that we need to seek permission for the care provider eg)midwife or doctor before commencing treatment. I dont know what the wording was exactly but Im sure it said something about it being a legal requirement. Having read all the post on this treaad I now believe you are right that this may be Gateways way of protecting themselves by being over zealous. Definately not a Northern Irish law of any kind...were not that different over here. trust me. lol. Its very difficult to know how to approach treatments sometimes when the training advice seems to contradict the tried and tested methods of experienced professionals.
It hasnt really been an issue until now but I felt a little stupid when this client rang me back today. I felt inferior and also felt a little sorry for my client having put her in the postion of having to ask and then getting laughed at. I am very confident about my skills in massage and like most as a precaution I wait for the client to be at least 12 weeks before she knowingly begins her pg treatment. I believe when I got my insurance with GHT all my treatments were discussed therefore I would be covered. but I could ring anf double check. I would be really happy and glad not to have to go through this process of requesting permission and having to wait another week until a potential client sees her midwife.... if I didnt have to.
thanks K

If someone can tell us all if it is a legal requirement to have permission from a doctor/midwife, it would be nice to know.

And a link to a formal organisation stating this with all the legal jargon.

Sorry Karen that you feel uneasy about this situation. I wouldn't let some arrogant medic get me down - probably he was some privately educated, upper mid-class w***er.

best wishes

RP

As far as I understand it, it is only if they are in the high risk category that you would need medial advice, a normal pregnancy is not a disease or a risk, it is a natural occurrence within the body.

thanks Paul,

So by that reckoning and I am to trust that when I ask if my client is having a normal pregnancy and that there are no indications in which massage may affect her pregnancy eg diabetees blood pressure... that she is fit and well and treat her like any other client. perform a consultation and if anything ontoward pops up and I am unsure then pursue the usual channels.

Is it contraindications and over cautious exam board and bodies gone mad again... Am I taking the manual too literally, should I trust my professional judgement.

RK - I just couldnt believe the arrogance of this doctor and her unwillingness to work together with complementary therapist/therapies.

Is there some legal guideline that would come back and bite me should a client decide to claim?

Hi Karen

Unfortunately many doctors don't believe in CAM. The culture of medicine doesn't allow for it, for institutional/educational and scientific reasons, and believe it or not: religion! And not forgetting time & resources.

As for disclaimers, how "strong" they hold up in a court of law I cannot say. Anyone can answer that one? Keeping good records is important including discussing any issues with the client, and making sure that if the client has a medical issue, that the care given is appropriate and if necessary any referral to other healthcare providers.

At the end of the day there is risk in treating any client for any reason. That is why we have insurance coverage.

Late last year I was offered a pregnancy massage job, but for the first time I said no as she was in the 1st trimester and it was an instable pregnancy involving idential triplets, and she was having laser treatment. Unfortunately she did lose the babies. Would me giving bodywork caused any problems, who knows, but I'm glad I used my intuition and professional judgement on that one.

Best wishes

RP

Thankyou very much for all you feedback. it has most definately filled in the gaps for me. I shall continue to continue good practice with professional judgement and caution where I deem most neccessary; contant GP's only where there is a medical contraindication that I fear is beyond my training, with good record keeping and keeping my clients well informed and referrals when neccessary.

much appreciated

Karen

I was taught to seek permission first. I was so happy when I met my first pregnant client. When I asked her to 'seek permission' I received an email a week later and she said her Doctor told her "Not to mess around with these things, and she could do what ever she wanted to do to her body after the pregnancy...".

I was so angry, shocked and confused that without any professional knowledge about me I was ridiculed and made to feel like a charlatan.

Now when I meet a new pregnanct client I tell them to advise their physicians that they are receiving complementary treatments.