High Risk Pregnancy Massage

Replies to This Discussion

Permalink Reply by Elaine Stillerman, LMT on February 28, 2010 at 1:20pm

"High risk" is a highly ambiguous term. One care provider's definition might conflict with another. Take maternal age, for instance. Pregnant women over 35 are considered to be 'high risk' in this country by many health care providers. Although there is often no compelling medical need, they are more likely to have c-sections than younger gravidas. But how does the effect the massage? Generally speaking, it doesn't. And there are numerous 'risk' factors (ie multiples, ART, etc) that have little or no effect on bodywork.

I call those the 'low level risk factors'. There are 'mid'level' risk factors that do require certain adaptation or alterations to bodywork technique. These may include a preexisting condition, exposure to DES in utero, recent surgery, trauma, or injury etc. All adaptations and modifications are determined on a personal basis.

Bottom line - practitioners without proper training should not massage pregnant women, especially those considered to be 'high risk'.

Elaine Stillerman, LMT
www.MotherMassage.Net

Permalink Reply by Susan G. Salvo on February 28, 2010 at 1:45pm

Thanks Elaine!

Elaine Stillerman, LMT said:

"High risk" is a highly ambiguous term. One care provider's definition might conflict with another. Take maternal age, for instance. Pregnant women over 35 are considered to be 'high risk' in this country by many health care providers. Although there is often no compelling medical need, they are more likely to have c-sections than younger gravidas. But how does the effect the massage? Generally speaking, it doesn't. And there are numerous 'risk' factors (ie multiples, ART, etc) that have little or no effect on bodywork.

I call those the 'low level risk factors'. There are 'mid'level' risk factors that do require certain adaptation or alterations to bodywork technique. These may include a preexisting condition, exposure to DES in utero, recent surgery, trauma, or injury etc. All adaptations and modifications are determined on a personal basis.

Bottom line - practitioners without proper training should not massage pregnant women, especially those considered to be 'high risk'.

Elaine Stillerman, LMT
www.MotherMassage.Net

Permalink Reply by Robin Byler Thomas on February 28, 2010 at 3:54pm

I also consider her high risk if she's had a previous miscarrage; doesn't mean I won't work on her but I will ask for the docs permision and have her sign consent/release forms. Then it depends on our relationship, how well I know her body, and how well informed she is.

Permalink Reply by Rebecca Overson on February 28, 2010 at 5:06pm

It's not how WE define High Risk Pregnancy since we don't diagnose... :) It's how the American College of Obstetrics and Gynecology defines it. There are several factors, that when present, make a woman at a higher risk for complications during pregnancy and delivery. They are listed on my website, www.bellyblissmassage.com on the Policies page.

I am fine working with high risk clients as long as I first obtain a release form from their physician stating that massage is OK for them, and the physician notes any alterations to bodywork and massage.

Basically what I do is, when a client calls to book a massage, I ask them a few questions, one of which is "Is everything progressing normally in your pregnancy or do you have any risk factors?"

Regardless of the answer, I ALWAYS email my client information form to them well in advance of their session and ask them to return it at least 24 hours in advance of their session. That way I have the opportunity to review it for any risk factors.

If there are risks present, I let them know that I need to obtain a release form from their physician or midwife prior to them receiving massage. I have a space in the intake form where they provide their doc's info, so I simply call the doc, get their fax number, and fax over a form with a cover sheet. This can take some time, so it's important to communicate with the office manager or nurse to see when they will be likely to return the form to me - nobody wants to piss off a pregnant woman by having her show up for a massage when you don't have clearance give one to her!

I try to make this process as simple and clear as possible, for "customer service" reasons. They are coming to me for comfort and relaxation, so I try not to trouble them or make it seem complicated.

So there you have it.

I have a ton of info on my website - feel free to check it out. Just don't copy anything from my copyrighted website ;)

OH and one other thing, though ACOG considers maternal age over 35 a high risk, I really have no problem with that if that is the only so-called risk factor. If she's healthy and has no other risks present, I don't require a release form simply because she's over 35.

And I totally agree with Elaine that if a therapist doesn't have confidence, experience, and training working with pregnant women, they should not perform massage therapy on a pregnant woman.

Thanks for starting the discussion, Rick.

BTW, I did some work for AKS Massage school back in 2000-2001 when I lived in Northern Virginia .... lovely place!

Permalink Reply by Robin Byler Thomas on February 28, 2010 at 8:05pm

"High risk" is a highly ambiguous term. One care provider's definition might conflict with another.

As Elaine pointed out physician diagnosis is often conflicting. If I have any concerns about my clients safety I will ask her to wait until she's safely through the first semester.

I have turned away clients, under other circumstances, who were sent to me by their doctors with counter indications for massage. Yes, physicians diagnose, but we do the evaluations and make the determination of MT.

Rebecca Overson said:

It's not how WE define High Risk Pregnancy since we don't diagnose... :) It's how the American College of Obstetrics and Gynecology defines it. There are several factors, that when present, make a woman at a higher risk for complications during pregnancy and delivery. They are listed on my website, www.bellyblissmassage.com on the Policies page.

I am fine working with high risk clients as long as I first obtain a release form from their physician stating that massage is OK for them, and the physician notes any alterations to bodywork and massage.

Basically what I do is, when a client calls to book a massage, I ask them a few questions, one of which is "Is everything progressing normally in your pregnancy or do you have any risk factors?"

Regardless of the answer, I ALWAYS email my client information form to them well in advance of their session and ask them to return it at least 24 hours in advance of their session. That way I have the opportunity to review it for any risk factors.

If there are risks present, I let them know that I need to obtain a release form from their physician or midwife prior to them receiving massage. I have a space in the intake form where they provide their doc's info, so I simply call the doc, get their fax number, and fax over a form with a cover sheet. This can take some time, so it's important to communicate with the office manager or nurse to see when they will be likely to return the form to me - nobody wants to piss off a pregnant woman by having her show up for a massage when you don't have clearance give one to her!

I try to make this process as simple and clear as possible, for "customer service" reasons. They are coming to me for comfort and relaxation, so I try not to trouble them or make it seem complicated.

So there you have it.

I have a ton of info on my website - feel free to check it out. Just don't copy anything from my copyrighted website ;)

OH and one other thing, though ACOG considers maternal age over 35 a high risk, I really have no problem with that if that is the only so-called risk factor. If she's healthy and has no other risks present, I don't require a release form simply because she's over 35.

And I totally agree with Elaine that if a therapist doesn't have confidence, experience, and training working with pregnant women, they should not perform massage therapy on a pregnant woman.

Thanks for starting the discussion, Rick.

BTW, I did some work for AKS Massage school back in 2000-2001 when I lived in Northern Virginia .... lovely place!

Permalink Reply by Susan G. Salvo on March 11, 2010 at 5:21am

Can anyone site an instance where a pregnant client was harmed by a licensed therapist during massage?

Permalink Reply by Rebecca Overson on March 11, 2010 at 9:38am

Susan G. Salvo said:

Can anyone site an instance where a pregnant client was harmed by a licensed therapist during massage?

Susan, I think (and it's foggy) there was one instance where a client tried to sue for something, like a miscarriage, but the jury threw it out. I might be confusing this with something else, so I'll see if I can find anything.

Permalink Reply by Exie Buehler on April 4, 2010 at 9:32pm

Hi Rebecca,
I totally agree with you! Although I am an educated and certified prenatal massage therapist and doula, I am not qualified to label a woman "high-risk", nor am I qualified to disregard the diagnosis that is given by her prenatal medical provider, be that a midwife or OB. If a woman is considered "high-risk", I will request a release signed by her provider on a prescription pad and will make sure that I have the contact information from that provider in case I need to contact them. I love working with prenatal clients and believe that massage during pregnancy, even when modified for "high-risk" clients, can be extremely helpful and beneficial.

Rebecca Overson said:

It's not how WE define High Risk Pregnancy since we don't diagnose... :) It's how the American College of Obstetrics and Gynecology defines it. There are several factors, that when present, make a woman at a higher risk for complications during pregnancy and delivery. They are listed on my website, www.bellyblissmassage.com on the Policies page.

I am fine working with high risk clients as long as I first obtain a release form from their physician stating that massage is OK for them, and the physician notes any alterations to bodywork and massage.

Basically what I do is, when a client calls to book a massage, I ask them a few questions, one of which is "Is everything progressing normally in your pregnancy or do you have any risk factors?"

Regardless of the answer, I ALWAYS email my client information form to them well in advance of their session and ask them to return it at least 24 hours in advance of their session. That way I have the opportunity to review it for any risk factors.

If there are risks present, I let them know that I need to obtain a release form from their physician or midwife prior to them receiving massage. I have a space in the intake form where they provide their doc's info, so I simply call the doc, get their fax number, and fax over a form with a cover sheet. This can take some time, so it's important to communicate with the office manager or nurse to see when they will be likely to return the form to me - nobody wants to piss off a pregnant woman by having her show up for a massage when you don't have clearance give one to her!

I try to make this process as simple and clear as possible, for "customer service" reasons. They are coming to me for comfort and relaxation, so I try not to trouble them or make it seem complicated.

So there you have it.

I have a ton of info on my website - feel free to check it out. Just don't copy anything from my copyrighted website ;)

OH and one other thing, though ACOG considers maternal age over 35 a high risk, I really have no problem with that if that is the only so-called risk factor. If she's healthy and has no other risks present, I don't require a release form simply because she's over 35.

And I totally agree with Elaine that if a therapist doesn't have confidence, experience, and training working with pregnant women, they should not perform massage therapy on a pregnant woman.

Thanks for starting the discussion, Rick.

BTW, I did some work for AKS Massage school back in 2000-2001 when I lived in Northern Virginia .... lovely place!

Permalink Reply by Jeanne Riley on April 5, 2010 at 7:43am

Susan, You asked
"Can anyone site an instance where a pregnant client was harmed by a licensed therapist during massage."

My sister was in her 26th (26.5 actually)week of a high risk pregancy (twins, invitro fertilization) and feeling very stressed when her doctor suggested she try to relax and go get a "massage or something". She followed dr's orders and found the first untrained MT she could find. She left the massage in labor. It was too late to stop the labor progression by the time she arrived at the hospital. She delivered 2 tiny beautiful peaceful boys who lived for a couple of hours before passing on. Can I say the massage definately caused her to go into labor? Can I prove it? No, but I know in my heart it contributed. Talking to my sister about it makes me angry. The MT knew she could not lie on her stomach, so had her flat on her back for an hour. (grr!) Because her feet were swollen (hello?) and sore the MT spent a great deal of time massaging her feet. This was a decade ago and she has a beautiful little boy from a subsequent pregnancy. I was not an MT when this happened (a decade ago)or I would have saught this person out and at the very least let them know what happened and perhaps encouraged them to get additional training or stay away from high risk pregnancies. My sister at the time was too busy grieving to go back. She wanted to move on and did not even contact the MT again to let her know what happened. So if you think you've done no harm...do you reall know for sure? If it is high risk, it is not worth the risk without advanced training. The baby can not speak up and say I am in distress and a first time mother is experiencing so many changes with her body that she may not be aware of a physiological change that is not OK until it is too late.

Permalink Reply by Susan G. Salvo on April 5, 2010 at 9:15am

Oh Jeanne, I am so sorry to hear about your family’s loss.

When I was 43 and pregnant with twins, anytime I felt funny, my OB would have me come in to check me out.

I wish programs included more information about pregnancy massage and having discussion about high risk pregnancies at entry level (i.e., an aspect of licensure rather than post-graduate “voluntary” certification). Then therapists would make appropriate safe practice decisions.

The sooner MTs have this essential information, the better off our clients are.


Jeanne Riley said:

Susan, You asked
"Can anyone site an instance where a pregnant client was harmed by a licensed therapist during massage."

My sister was in her 26th (26.5 actually)week of a high risk pregancy (twins, invitro fertilization) and feeling very stressed when her doctor suggested she try to relax and go get a "massage or something". She followed dr's orders and found the first untrained MT she could find. She left the massage in labor. It was too late to stop the labor progression by the time she arrived at the hospital. She delivered 2 tiny beautiful peaceful boys who lived for a couple of hours before passing on. Can I say the massage definately caused her to go into labor? Can I prove it? No, but I know in my heart it contributed. Talking to my sister about it makes me angry. The MT knew she could not lie on her stomach, so had her flat on her back for an hour. (grr!) Because her feet were swollen (hello?) and sore the MT spent a great deal of time massaging her feet. This was a decade ago and she has a beautiful little boy from a subsequent pregnancy. I was not an MT when this happened (a decade ago)or I would have saught this person out and at the very least let them know what happened and perhaps encouraged them to get additional training or stay away from high risk pregnancies. My sister at the time was too busy grieving to go back. She wanted to move on and did not even contact the MT again to let her know what happened. So if you think you've done no harm...do you reall know for sure? If it is high risk, it is not worth the risk without advanced training. The baby can not speak up and say I am in distress and a first time mother is experiencing so many changes with her body that she may not be aware of a physiological change that is not OK until it is too late.