Working with pregnancy clients

[confused guy1-1]

Ok folks... especially you doulas and such... help me out with the general picture here.

My client was back again and wanted "anything to help with the low back"... she's beginning to feel her center of gravity changing and experiencing pressure in her low back.

I did a combination of my old style of low back work with some of the orthopedic techniques I just learned... I only worked the psoas energetically though. And afterward she said she felt great. We talked about some stretches to do.

I'm glad we did all of that now while she's still this early in pregnancy... what's going to happen over the next 5-6 months though?

Would it have been ok to more physically work the psoas? Are there any stretches she shouldn't do? What should I be aware of in terms of the lower back and changes that will affect that area? What can I reasonably expect to help with? What should I avoid?

Any books you recommend?

I don't need you to certify me in pregnancy massage remotely, just help me get through this client! Above all, I don't want to do anything harmful, of course.

 

[Kat :D]

There is a Pregnancy massage video on U-Tube - the draping is really awesome. I can't access it at the moment to post it, but you can search "pregnancy massage" on the site to find.

 

[Abby A]

Not to negate your own knowledge of this particular client's body, I want to point out that sometimes low back pain in pregnancy comes from the ligaments that attach there from the uterus. When I was pregnant my mother who is a nurse let me borrow her books from school about the changes the female body goes through during pregnancy. It's amazing!

I would not recommend working the psoas digitally, but I was doing yoga from 6-8 months so gentle conscience stretching should be favorable, as well as general exercise if she's not high risk.

She might be at a point in her pregnancy in which hormones are starting to loosen her pelvis and the extra movement might be causing discomfort. The weight of the baby might be putting pressure on areas of her body that lead to pain.

My general advice is that if she didn't have postural problems before pregnancy that caused pain, then she doesn't necessarily need "postural work" now. I am in the camp that believes the female body doesn't need much outside help during this process. A good nurturing and soothing touch to relieve pressure or pain is enough. But this is from personal experience and not from a class or extra studying. Pain and discomfort is part of pregnancy and only the slightest precursor to the pain involved in labor/delivery and then the roller coaster ride of having a kid outside of the body to take care of.

The book that I have on my shelf is Mother Massage by Elaine Stillerman, LMT and that might help, but even googling body changes during pregnancy could give you some relevant information about the amazing process of gestation.

I hope others have great books about pregnancy to share.

Good luck!!

Editing to add this quote:

In the classically normal anteflexed uterus, there are a number of ligaments that hold it in that position. The uterosacral ligaments go from the cervix, through the vaginal wall, and then insert on the sacrum. A growing pregnant uterus will twang these ligaments giving the famous lower back pain. The round ligaments originate from the sides of the uterus, travel away from it toward the pelvic sidewalls where they travel through the inguinal rings and then spread to insert on the vaginal sidewalls and inner thighs. A growing pregnant uterus will stretch these as well, giving the frequent "round ligament" pain that hurts usually to one side in the inguinal region. The main support for the uterus are the cardinal ligaments, tough fibrous supports that line the sides of the lower part of the uterus. The other ligaments are often lax long before the cardinal ligaments ever weaken.

from this site: http://www.gynob.com/utepro.htm which has other interesting facts about female anatomy and pregnancy.

 

[Pompal 09.]

Thanks folks, this is all great info. Any more would be greatly appreciated.

 

[Pompal 09.]

I would recommend teaching her to tuck the sacrum. She can do this as an exercise. Also, show her how to do myofascial push of the abdominal skin toward and into the linea alba. This provides support and increases integrity of the fascia of the expanding abdomen and can help a lot with low back pain.

You can work iliacus during pregnancy, and do some AIS for TFL, and also for the trunk and hip flexors, (preferably in sidelying,) if her ROM is restricted.

You can still assess and treat postural distortions if they exist, as long as you are careful and go slow, taking into account the hormones may make her more prone to stretch injuries if you are too aggressive with assisted stretches.

 

[dkomarovska]

I also recommend asking her to keep you updated on patterns of nausea or other ill feelings, and whether her medical pros have any concerns. Definitely read up on some of the physical changes she'll undergo. Knowing the warning signs of pre-eclampsia and other potential complications is also a good idea.

In general, she can be supine during the first trimester, but it's best to have a cushion or wedge bolster under the right hip, especially as she begins showing. Sidelying is fine, prone is probably okay until she starts showing - a body cushion setup works well if you have one.

During the second trimester, she should be able to sit supine, but sitting more upright at 45 degree or higher. Use bolsters and cushions for this, and consider keeping the cushion under her right hip. Sidelying is good, and body cushion setups are great for prone.

During the third trimester, you can bolster for a more upright seated supine position (as above) or use sidelying. Prone positioning is iffy, best done with body cushion setups.

When she starts to show and you use sidelying, place a small wedge cushion under the bump. This will relieve stress on her connective tissues in that position.

Hope that too-brief summary helps. If medical complications arise, please share them here for guidance on safely adapting your work.

 

[John de Witt]

This weekend we had a 5 months pregnant LMT in the orthomassage workshop. She was able to perform and receive nearly all the work with the exception of psoas, deep work near the sacrum, and the deep post-tib work.

For some of the work we simply placed a 6" round bolster under her belly when she was prone. She said it was quite comfortable.

Pregnant women are not fragile, as long as the pregnancy is not with complications. After all, they spend 9 months growing another human, 4-5 months having that little thing kick her organs from inside the abdomen. :

 

[DWebb88-RIP MJ]

MOST pregnant women are very resilient, no doubt about that!! :

But for MTs that are just starting to work with pregnant clients, caution is good. Even the healthiest women may miscarry (for whatever reason), and we don't want them to feel their MT took unnecessary risks and endangered the pregnancy. As the massage professional, we are supposed to be one of the experts they can trust.

A pregnant LMT, on the other hand, has a better grasp of the risks and may make her own choices regarding receiving massage during term.

 

[pivotfreaker]

Was avoiding the deep post tib work because of reflex points in that area?

Also, show her how to do myofascial push of the abdominal skin toward and into the linea alba. This provides support and increases integrity of the fascia of the expanding abdomen and can help a lot with low back pain.

Where did you learn about this in relation to pregnancy? I'd like to understand more about the rationale here before recommending it.