Pregnancy, Labor, Postpartum Bodywork

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Comment by leslie stager on May 11, 2015 at 4:07pm

NEWS FLASH ABOUT CLOTS/DVTS/PE DURING PREGNANCY/POSTPARTUM:

 I"ve been teaching pre and perinatal bodywork for 22 years. I am textbook author of Nurturing Massage for Pregnancy.  Because of a  5-6x increased risk of DVT during pregnancy/postpartum, I have generally supported a standard protocol of avoiding deep bodywork to the adductors and calves during that period. Most DVT's are found in the calf region during pregnancy, a bunch in the adductor region, 10% in the pelvis. AND Most that embolize are actually NON-symptomatic.

 Therefore there may be no clear signs of the most dangerous blood clots.

In light of that, I thought perhaps it best to encourage practicing as though any pregnant woman could have an undiagnosed DVT, as some could.  I have always wondered if this was an unnecessary fear-based precaution though. I am all about busting myths about the dangers of pregnancy massage, so this has bugged me and I have continued seeking  info and research over the years.

I just heard back from a high-risk OB-GYN from Duke University, and have conferred with other colleagues now, who have also spoken to vascular surgeons,  and OB-GYN's.  The conclusion and response: No clot precautions are necessary for non-symptomatic pregnant women. The risk for DVT is 1:1000 pregnant women. The experts feel it’s not high enough to have across-the-board massage precautions.

That said, knowing who is at greater risk is important: Pregnant and postpartum women who have flown by plane, been immobilized or on bedrest,  have a history of a clot, genetic disposition to clotting issues, are obese, had surgery/c-section, ... these women are especially at risk for developing clots, and I would then say to PRACTICE THE PRECAUTIONS in these cases for no deep work to the areas of concern.

It is important to note that for any woman on blood thinners for a known clot, bodywork must be light to moderate to avoid causing bruising and tissue bleeding. Obviously don’t work distal to or on top of the clot area. (Although plenty of clients with a clot will ask you to work there, because they are uncomfortable!).

 Dr. James also said, that apart from the anti-coagulant precautions, it is actually fine to do gentle massage Proximal to the clot without concern of dislodging clot.

 

Comment by leslie stager on April 12, 2015 at 10:04pm

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Comment by leslie stager on August 31, 2014 at 3:42pm

HI Heather, My personal preference for the past 20+ years is the BodySupport Systems Body Cushion.  I have used it with all clients, pregnant and not. It's versatile enough to give optimum comfort for sidelying, supine, prone, and semi-reclining without alot of fussing. I think I've seen all the systems available, as my students often come with something they've bought in the past or for class, and still we all end up liking BodySupport Systems best. However, it is very expensive and the quality of their foam seems to have changed over the years so  a bit stiffer than they used to be, so some edges seem a bit pokey. They have an additional piece great for large breasted women positioning prone (such as lactating postpartum mothers)  Many students  find them on craigslist or ebay. I just bought the system recently for $100 from someone posting on Facebook!

Comment by Heather Jones on August 27, 2014 at 6:17pm

I am in the market for prenatal cushions for some of my clients.  At the prior spa I worked for they had in house the pregnancy pillow maternity cushion bolster set.  I am wondering if that is the best for all of my clients.  I noticed as the baby grew it was more difficult for my clients to find comfort in this system.  It was a great system for the new pregnant Mom's.  I see that Oakworks makes a cushion system for side lying and the lists continues from other companies.  What is everyone using now a days for pregnancy support cushions?  

Comment by Gordon J. Wallis on January 7, 2014 at 6:02pm

Hi Laura.  I do trigger point work on pregnant women.  You have to assess if the client is healthy or not so healthy. I mean if she has a history of miscarriages and or super unhealthy looking, maybe not. But she sounds fine because she is already using a tennis ball.  You can certainly work her upper back, neck, hips and legs.  No deep work  on the lower back or abdominal area maybe.  

Comment by leslie stager on January 7, 2014 at 5:51pm

HI Laura, There may be concern with deep work if someone has had multiple miscarriages and is still earlier than 20 weeks gestation or so. Has there been an association of deep or TP work with miscarriage? Not that I've ever found, however,  I do know of women who have wondered about it when they  miscarried after deep work. I suggest avoiding the concern by doing more supportive work and less intensive release work until past that time. (note, that does not mean don't do any deep work at all)

Because the body is changing so much, and relaxin is in effect in all the ligaments, I would  avoid a Full Body approach with TP, deep tissue, or Structural Integration type work... Too much can simply be Too much during pregnancy when so much is being formed, integrated, and generated...too much can destabilize and have painful backlash.  Otherwise, not in high risk category, or beyond that high risk miscarriage time... I'd say go for it with focused TP work.!

Comment by Laura Garza on January 7, 2014 at 2:44pm

Hi!  I have a new client who is 20 weeks with myofascial pain syndrome.  She is looking to have trigger point therapy done.  I do both pre-natal and trp work but not together.  Any advice?  She uses a tennis ball daily and says she has been getting trigger points released.  My inclination is to only do light trigger point work.

Comment by leslie stager on May 19, 2013 at 12:17am

Yes.. What I find is that many students try to use puffy type pillows , with lots of loft. They end up falling off the table, or legs fall off because they are too bouncy.  WHen I say Flat, I mean ... well, like a dead pillow!.. the ones that are squished down and solid so that you can layer them, and they won't go anywhere!

Comment by Bethany Reed on May 18, 2013 at 7:29pm

Thank you for the clarification, semi-supine is exactly what I was meaning.  In my head it just registers as supine, pregnancy style hehe.  I am assuming that when you refer to using 3 flat pillows you're meaning them to be pretty flat?  The one's I've got have some good life to them & if I used 3 of them her knee would be well above proper alignment.  Just for clarity. 

Comment by leslie stager on May 17, 2013 at 9:36pm

HI there! I'm a former labor and delivery nurse and developer/ instructor of 60-hour MotherTouch Maternity Massage certification program. Also author of the textbook Nurturing Massage for Pregnancy, published in 2008 by Lippincott. I"d like to add to the discussion a few considerations and a clarification.

Supine positioning is generally considered to be lying on your back (on your Spine - supine). After 2nd trimester, no pregnant clients should be supine for long due to potential for compression on the vena cava/aorta. Not to pick beans, but sounds like you are referring to semi-reclining or semi-fowlers position! Sometimes called Semi-supine. Usually about 45 degree angle of support. This prevents compression on those big blood vessels. 

Pillows: PErsonally, I love the bodysupport system body cushion for all clients, pregnant or not. It offers great support for sidelying preventing compression on the shoulder plexus, supports under the belly to prevent strain on uterine broad ligament, lengthens the lumbar curve in prone positioning, has recesses for breasts and bellies when in prone position, folds up to be supportive for semi-reclining, and opens the chest and shoulders in supine position.  The bolster is solid and I only need 1-2 flat pillows on top of that for sidelying leg support. It eliminates alot of pillow shuffling!

However, I teach the use of pillows for students who do not have the body cushion. I work primarily in sidelying because it is awesome, comfortable, relaxing and gives great access to the whole body. I like it also for all clients pregnant or not!

Sidelying:  1 pillow under head, keeping cervical spine straight. 1 wedge under larger belly. Usually 3 Flat pillows under the legs, to ensure that the knee and trochanter are aligned, so that lateral hip rotators are in neutral, 1 pillow under the arm to prevent breast compression (over the sheet, that helps secure the sheet draping. )This is all demonstrated in my Mastering Pregnancy Massage DVD--3 hours of detailed instruction!

Lastly.. if you are on Linked In, there are a bunch of massage groups that have been having  some interesting discussions about pregnancy massage.

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