I provide Naturopathic Midwifery services in a family practice setting.  My specialty training is in providing naturopathic prenatal care, home births, post-partum and pediatric care.  I see women and their family members through all cycles of life, preconception, pregnancy, labor & delivery, post-partum, well woman care, annual physicals, and then pediatric care for the new family member.  I have two children, both born at home with a Naturopathic physician/midwife.  I can attest to the importance of pregnancy massage both as a physician and as a patient.  When my pregnant patients are looking for massage services, I specifically recommend that they find a provider that utilizes the cut out tables in their practice.  It is my opinion that while in the prone (face down) position with the appropriate section removed to allow the abdomen (and baby) to freely suspend with the support of the sling, that the mother is in the best position to receive a massage.  Most pregnancy massages average 45-90 minutes long in duration and while the mother is receiving therapeutic massage, she may actually be hurting herself or the baby if not in the best position.  Many massage locations will have mother’s side-lie.  This position is not only uncomfortable for longer durations of time, it also decreases maternal return blood flow to the heart from the lower extremity when the mother lies on her right side.  This decrease in maternal blood flow then disrupts the circulation flowing to the baby and can reduce the amount of oxygen the baby receives from the placenta.  Some women experience a transient increase in blood pressure while lying on their right side (from baby lying on maternal inferior vena cava, the large blood vessel returning blood to mother’s heart), other’s may have a sensation of faintness likely from blood vessel compression, other’s may have concomitant sciatic or hip pain that may worsen with side lying positions.  As a mother lies in the prone position with a specialty table designed for pregnant women, the maternal circulation remains consistent throughout her body, the baby does not compress maternal inferior vena cava, pressure is off of maternal hip joints, and the mother is allowed to be in the most comfortable position to then relax and enjoy her massage.

Krystal Tellier, ND
Health For Life Naturopathic Medicine
16601 N. 40th Street, Suite 124
Phoenix, AZ  85032
Office: 602-368-9211

www.DrKrystalTellier.com

Dr. Christina Kovalik NMD, LAc. is a Naturopathic Physician and Acupuncturist with a passion for transforming women and their families naturally. Dr. Kovalik loves assisting women in transitions specifically fertility wellness, pregnancy and postpartum support, hormone imbalance for men and women and menopausal stages of life. Dr. Kovalik utilizes acupuncture, botanicals, nutrition, homeopathy and energy medicine to address the root cause of the imbalance naturally. Acupuncture is safe during all phases of pregnancy and can be used to minimize nausea, low back pain, labor pain management and minimize postpartum depression. It is often an adjunctive therapy to chiropractic, hypnotherapy, massage, and obstetric wellness.  Dr. Kavlik is a member of the Natural Birthing Solutions group.  

“I would highly recommend massage at any stage of pregnancy because it can reduce the stress on the mother and baby by inducing relaxation. It can be used for any muscle aches and pains common during pregnancy. I have two children of my own and had massage, chiropractic and acupuncture during each pregnancy. I know that the combination of these therapies made my pregnancies more relaxed and prepared my body for the birthing process. I feel that clients would highly benefit from massage on the cut out tables that Elements Therapeutic Massage offers to deepen relaxation while alleviating the pressure on the body from the beautiful growing belly.”
Dr. Christina Kovalik NMD, LAc.

You may contact Dr. Kovalik at:
Dr. Christina Kovalik NMD, LAc.
10405 N. Scottsdale Road, Ste. 3
Scottsdale, AZ 85253
602-434-7922
www.drkovalik.com

Article by: Jennifer Iacovelli, MD (Drs. Goodman & Partridge, OBGYN)

Prenatal Massage

Massage therapy is used to improve overall health, decrease stress, and relieve muscle aches and pains. Pregnant women have received varying responses regarding the safety and indications of massage during pregnancy. Data has proven that prenatal massage can be an important addition to prenatal care and should be considered when appropriate.  If contemplating prenatal massage, find a therapist who is certified in prenatal massage.

Benefits of Prenatal Massage

Studies indicate that massage therapy during pregnancy can reduce anxiety, decrease depression, relieve muscle aches and joint pains, and improve labor outcomes and newborn health. Swedish massage is the recommended method during pregnancy because it addresses many discomforts associated with the skeletal and circulatory changes brought on by hormone shifts during pregnancy.

Hormone regulation

Data suggests hormone levels associated with relaxation and stress are altered, leading to mood regulation and improved cardiovascular health. Stress related hormones are reduced while hormones associated with relaxation and decreased depression is increased after massage. These changes in hormone levels lead to fewer complications during labor and delivery, as well as fewer instances of newborn complications, such as low birth weight.

Reduction of swelling

Edema of the joints during pregnancy can be caused by impaired circulation and increased pressure on the major blood vessels by the uterus. Massage stimulates soft tissues to reduce fluid accumulation in joints, which also improves the removal of tissue waste.

Improvement of nerve pain

Sciatica often occurs in pregnant women in the late second trimester and third trimester.  The pressure of the uterus spreads tension to the muscles of the upper and lower leg, causing them to swell and compress nearby nerves. Massage decreases inflammation of nerves (and, therefore, sciatica) by helping to release the tension on nearby muscles. Many women have experienced significant reduction in sciatic nerve pain during pregnancy through regular massage.

Other benefits of prenatal massage:

• Reduced back and joint pain
• Improved circulation
• Improves skin elasticity, reducing stretch marks
• Reduced muscle tension and headaches
• Reduced stress and anxiety
• Prepares body for delivery by loosening pelvis and reducing tension
• Improved oxygenation of soft tissues and muscles
• Better sleep
• Improves digestion
• Relaxes and soothes fetus

Precautions to take when seeking Prenatal Massage

Women should discuss massage with their prenatal care provider. The best way to address the risks of prenatal massage is to be well informed and to work together with knowledgeable massage therapists.

Body position during prenatal massage

Many consider the best position for a pregnant woman during massage is side-lying. Tables that provide a hole in which the uterus can fit (some tables also have holes where the breasts fit through) are becoming more popular, specifically in facilities tailored to prenatal massage.  Consult your massage therapist before your first appointment to verify what position they place their clients in during the massage.

Side lying benefits:

• Less stretching of uterine ligaments
• Less strain on tender breasts
• Reduces aggravation of heartburn (verses lying prone)
• Reduces sinus congestion
• Facilitates performing various stretches on patient

 Side lying drawbacks:

• Constant moving and repositioning of patient
• Some mothers feel like they are lying on their baby
• Inability of get relief in all areas due to lack of access
• Lying on the right side for too long may compress vena cava

Cut out table benefits:

• Overall more comfortable
• Patients often can stretch out more than when lying on side
• Some moms miss lying on tummy
• Therapists can better access entire body and conduct more efficacious massage of lower back, extremities, ligaments and front/back of legs
• Overall better circulation with a more thorough massage
• 99% of patients prefer this position due to side lying

Cut out table drawbacks:

• May increase uterine pressure
• Sinus congestion (typical in all massage, pregnant and non-pregnant)
• Heartburn
• Tender breasts (if breast cut outs are not used as well)

Seek out a massage therapist experienced in prenatal massage

It is important to seek care from a certified prenatal massage therapist. Certified therapists have received training beyond the national standards for massage therapists and know how to address specific pregnancy needs and sensitive areas of the body.  Trained prenatal massage therapists are aware of pressure points on the ankles and wrists that can gently stimulate pelvic muscles, including the uterus. These therapists are trained to avoid intentional pressure to these areas during pregnancy in order to decrease the likelihood of preterm contractions.

Women with the following conditions should speak with their health care provider prior to receiving a massage:

• High risk pregnancy
• Any disease process that massage would be contraindicated in the non-pregnant patient)
• Pregnancy induced hypertension or pre-eclampsia
• Vaginal bleeding (or if diagnosed with placenta previa)
• Abdominal pain
• History of blood clots
• History of preterm labor or preterm contractions in current pregnancy
• Severe swelling, high blood pressure, or sudden, severe headaches
• Decreased or no fetal movement over the past 24 hours
• Recent birth

Is prenatal massage safe throughout the entire pregnancy?

Women can receive massage at any point in their pregnancy, regardless of trimester. Many facilities refuse to massage women in the first trimester because of risk of miscarriage. This is untrue. There is no evidence that miscarriage has ever been caused by massage.  Some forms of massage can induce labor in advanced pregnancy, and this may be the origin of misconceptions regarding first trimester massage.  In fact, acupressure in some areas can reduce symptoms of morning sickness, a common symptom experienced in the first trimester.

Summary

The benefits of massage can improve overall prenatal health for pregnant women. Along with the advice of a prenatal care provider, massage can be incorporated into routine prenatal care. Nausea and dizziness can occur after any massage, pregnant or non-pregnant.  Avoid eating immediately before massage and get up from massage carefully to avoid problems.  Muscle soreness after massage is the result of not getting enough fluids after massage.  Drink plenty of water in the first two hours after massage to help prevent this.  Consult your health care provider before beginning any new therapeutic practice.