58 | MASSAGE Magazine | October 2010 | www.massagemag.com |

|Cover StoryM

For Pregnant, Laboring andPostpartum Women

iSTOCKPHOTOS

MaternityMassageTherapy

by Carole Osborne

Maternity-massage therapy is one of themost personally rewarding andprofessionally satisfyingmassage-therapy specializations.Maternity

massage addresses themany needs of womenthroughout an entire childbearing cycle, rather thanjust during pregnancy. If you are considering enteringtheworld of bellies roilingwith life, labor’s powerfulgroans and the sweetness of amom embracing hernewborn, youwill need a sense of what this reallyentails.

This article overviews this specialization, includingits history and current possibilities. You will get aglimpse at what practicing maternity-massagetherapy is like in the words of several seasonedpractitioners, and how to get the educationalfoundation you need to have similar success. You willlearn about the benefits of professional touch tomothers, babies and families, helping you toappreciate the widespread positive impact thatspecializing with this populationmight have forwomen and our world.

Hands-on supportMaternity-massage therapy is the use of

therapeutic massage and bodywork to support the

physiologic, structural and emotional well-being ofpregnant, laboring and postpartumwomen. Sometherapists expand their support to the pre-conceptionperiod or to the long-termwell-being of women for ayear or more after giving birth. Therapists may applyvarious forms of massage therapy, includingcirculatory, deep tissue, neuromuscular, passive andactive movement modalities, craniosacral and Asianbodywork therapies, among others.

A typical prenatal session, performed by a therapistspecializing in maternity-massage therapy, addressespregnancy’s various physical challenges, such as painin the lower back, pelvis or hips from postural andfunctional changes. Therapists emphasize autonomicsedation to maximize the stress-reducing effects toboth relax mom and improve uterine blood supply foroptimal fetal andmaternal outcomes.1 Many womenunburden their fears and other anxieties aboutchildbearing during their sessions. Some therapistsinclude techniques that may help the mother-to-bedevelop the sensory awareness necessary to birthmore comfortably and actively.

“With each new pregnant woman, I try to assumenothing and hope for nothing. I try to make that hourjust what she wants,” explains maternity-massagetherapist David Lobenstine of New York, New York. “If

| www.massagemag.com | October 2010 | MASSAGE Magazine | 59

Most of the world’s more peaceful culturesuse touch prominently during pregnancyand early childhood.

that just means she takes a good nap, then that’s exactlywhat she needed.”

Lobenstine says simple relaxation can be as profound asmore advanced techniques, but that his clients are oftensurprised at the depth of work that can be achieved in asingle 60-minute session.

“They are startled that we can cultivate change soquickly,” he says. “They are thrilled that we can alleviate

some of their rib tightness or make their lower back feellonger, or flush some of the density from their ankles.”

His pregnant clients realize, he adds, “that it is possibleto feel centered—even if only for a moment—in their ever-changing bodies.”

A growing specialtyOver the last three decades, thousands of licensedmassage

therapists have trained to becomematernity-massagetherapy specialists. But nurturing touch during pregnancy,labor and the postpartumperiod isn’t amodern concept.

For many centuries, midwives have used their highlydeveloped hands-on skills in supporting gestation andbirth. Massage andmovement during the childbearingexperience was and continues to be a prominent part ofmany cultures’ maternity care.2 Most of the world’s more

peaceful cultures use touch prominently during pregnancyand early childhood.3

When childbearing became increasingly medicalizedover the last 150 or so years inWestern countries,technology ascended over touch in caring for expectant andlaboring women.4 In addition, prior to the 1980s, mostmassage-therapy educators considered pregnancy acontraindicated condition for receiving massage. Around

then, several pioneering massage andbodywork therapists, intrigued by itspotential value to women and theirfamilies, explored, researched andassembled contemporary foundations forthe safe and effective practice of

maternity-massage therapy.This foundation includes a growing research basis for

the inclusion of maternity-massage therapy as an adjunct toperinatal health care. In animal research, scientists foundlack of cutaneous stimulation had far-reaching effects.Pregnant rats restricted from licking their abdomens andteats had poorly developed placentas and 50 percent lessmammary-gland development. Their litters were often ill,stillborn or died shortly after birth, in part due to poormothering skills.5

On the other hand, women whose care includedmoretouch enjoyed benefits for themselves, their infants andtheir families. Compared with those who had an equalamount of relaxation therapy, pregnant womenmassagedtwice weekly for five weeks experienced less anxiety anddecreased leg and back pain. They reported better sleep and

Read “PostpartumMassage Concerns,” by Judith Koch, director ofeducation for the Institute of Somatic Therapy and founder of the MassageDoula Network, at www.massagemag.com/postpartumconcerns.

|Cover StoryM

BBootthh sskkii ll ll aannddeeqquuiippmmeenntt——iinntthhiiss eexxaammppllee,, ttooccrreeaattee aannddmmaaiinnttaaiinn nneeuutt rraallaall iiggnnmmeenntt aannddssttaabbllee ssuuppppoorr tt ffoorrss iiddee--llyy iinnggppoossii tt iioonniinngg——aarreeeesssseennttiiaall ffoorreeffffeeccttii vvee,,ccoommffoorrttaabbllee aannddssaaffee pprreennaattaallmmaassssaaggee tthheerraappyy..

PHOTOS COURTESY OF CAROLE OSBORNE

60 | MASSAGE Magazine | October 2010 | www.massagemag.com |

improved moods, and their labors had fewercomplications, including less premature births.6 Depressedsecond trimester women had similar reductions in painand complications when they received massage therapyrather than relaxation sessions or normal prenatal care.7

Studies show when women receive nurturing touchduring later pregnancy, they touch their babies morefrequently and lovingly.8

When the touched half of 90 laboring women werecontacted reassuringly for just 5 to 10 seconds wheneverthey expressed anxiety, their blood pressure and number ofanxious expressions significantly decreased.9 Womenwhose partners massaged their head, back, hands and feetfor 20 minutes hourly for five hours of labor had less painand anxiety and improved mood.10 During labor, thepresence of a doula, a woman providing physical andemotional support, including extensive touching andmassage, reduces the length of labor and number ofcomplications, interventions, medications and Cesareanbirths.11 When massage therapists work with laboringwomen, they often report similar positive outcomes.

Current opportunitiesMost prenatal and perinatal massage-therapy specialists

work with women in their private practices. Like therapistswhose focus is on other hands-on specialties, word-of-mouth is one of the most successful means of marketing amaternity-massage practice.

“Even early on in my specialty practice for pregnantwoman I relied on word-of-mouth,” says Linda Hickey,R.M.T., owner of Calgary Maternity Massage in Calgary,Alberta, Canada. “I still maintain you only need one motherto come and experience our magic. She will soon see [other]pregnant women and share your name.”

Other maternity-massage therapists enjoy the growingemployment opportunities at spas, resorts, chiropractic andwellness centers catering to expectant women.

“Working in a spa with the unique needs of pregnantwomen can be both rewarding and frustrating,” explainsLobenstine. “Spa managements’ fear of our litigious society,and of bad publicity, often trumps a more rational approachto treatment. As my managers began to understand thedepth of my training in maternity-massage therapy, theybegan to value and utilize my expertise and that of othersimilarly trained therapists.”

He notes many women can be anxious about theirpregnancies, and the mixed messages offered by themedical community about the potential dangers of massagecan sometimes increase that anxiety.

“The front desk now mentions the details of ourcertifications when talking to clients,” he adds. “For a client

Visit www.massagemag.com/selfmassagetool to read “Self-Massage to Relieve Pain and Stiffness During Pregnancy,”by Tranquility Spheres Inc.’s Stephanie Whittier, L.M.T.

NNuurrttuurr iinngg,,tthheerraappeeuutt iiccmmaassssaaggee mmaayyeennhhaannccee aawwoommaann’’sseennjjooyymmeenntt ooff hheerrpprreeggnnaanncciieess,,aanndd ssaattiissffyy tthheetthheerraappiisstt ’’ssddeessiirree ttooccoonnttrr iibbuuttee ttoommootthheerrss’’ aannddbbaabbiieess’’ wweell ll--bbeeiinngg..

| www.massagemag.com | October 2010 | MASSAGE Magazine | 61

needing reassurance, just knowing that we have receivedspecialized training can put them at ease and make themmore willing to book an appointment.”

Lobenstine says he plays a valued role at his spa, “and Iknow that I am helping it function responsibly.”

The medical settingMidwives represent a natural fit for

partnership with maternity-massage therapists.“Get to know the allied birth professionals,

midwives especially, as well as yoga and

childbirth-education instructors in yourcommunity for your own referral list,” Hickeysuggests. “Find the people that match yourstyle and refer, [and] they will refer back intime, too.”

Physicians and hospitals are alsoincreasingly open to working with qualifiedmaternity-massage therapists.

“I have had the honor to work in thematernity department doing postpartummassage for Greenwich Hospital,” saysmaternity-massage therapist Lisa Faski ofGreenwich, Connecticut. “Patience,understanding and a flexibility of both timeand body mechanics are essential to successfulmassage sessions in a hospital setting.”

Working around hospital beds and havingequipment for innovative positioning ischallenging, adds Faski. Precautions must betaken to provide safety and to avoiddiscomfort.

“Many obstacles may stand in the way ofbeginning a session on time or continuingthrough without interruption,” she adds.“Despite these and other difficulties, therewards in this job are numerous. I am blessedto be a part of this very special time in the livesof these families.”

Some maternity-massage therapists havesuccessful cooperative ventures with othermassage therapists, and others hire qualifiedtherapists to staff their maternity-massagetherapy centers.12

Education Successful maternity-massage therapists

rely on comprehensive maternity knowledge at the core oftheir practices. After a few prenatal or postpartum sessions,most therapists find their basic massage traininginsufficient to safely meet the complex physiological,musculoskeletal and emotional concerns of thechildbearing year.

Find out how the American Pregnancy Massage Associationsupports pregnancy- and maternity-massage therapists atwww.massagemag.com/pregnancyassociation.

|Cover StoryM

62 | MASSAGE Magazine | October 2010 | www.massagemag.com |

Reaching into the creative realm of pregnancyoffers an abundance of magical moments anda promising career focus.

MMaassssaaggee tthheerraappyy mmaayy hheellpp ttoo rreell iieevvee mmuussccuulloosskkeelleettaallddiissccoommffoorrttss ooff pprreeggnnaannccyy.. HHeerree,, aauutthhoorr CCaarroollee OOssbboorrnnee ggeennttll yysstt rreettcchheess aa pprreeggnnaanntt ccll iieenntt’’ss aarrmm bbyy aappppllyy iinngg ggeennttllee tt rraaccttiioonn..

Available continuing education training ranges fromcourses of several hours to modular programs totaling asmany as 125 or 200 hours. Many employers require about30 hours of maternity-massage therapy instruction, andmost therapists find well-executed courses of this length tobe appropriate learning experiences for their needs.

“I opened Sage Spa about six years ago, after 15 years inprivate practice,” says Susan Stratton, owner of Sage Spa inBrooklyn, New York. “Our 14 staff therapists serve a generalclientele, including about 35 percent with maternityconcerns. All therapists complete specific, quality perinatalmassage-therapy training.”

Therapists “must not only be able to do this work, theymust also really want to do it,” Stratton adds. “They continueto learn, from each other and from the experts that I bring into expand their expertise.”

Effective curricula include: normal pre- and perinatalphysiology and progression, high risk factors and medicalcomplications of pregnancy; research-based protocols forhow to adapt your work or eliminate various massage-therapy techniques and methodologies, depending on theindividual, her health issues and trimester of pregnancy; howto effectively address common and specific prenatal, laborand postpartum needs; and how to consult with physiciansor midwives when conditions warrant.

Some courses include required evaluations for coursecompletion and certification. (Note: Most states have nospecified requirements to practice maternity-massagetherapy.) Many therapists particularly appreciate anapproach to maternity massage that is steeped in a deep trustfor the normalcy and joy of pregnancy, along with a respectfor its many challenges and possible risks.

Look for a course developed by a respected expert in thisspecialization and taught by experienced, career instructors.

Confer with therapists in your area with advanced perinataltraining for their impressions and advice on the value oftheir learning experiences. Compare curricula, completionrequirements and learning strategies to find the best matchfor your interests and perspectives. Some courses are moreexploratory of one’s own childbirth experiences; others aremore or less technical and clinical in their approach. Coursetechniques include differing modalities, and practicerecommendations on positioning, safety and effectivenesscan be frustratingly contradictory or inspiring in theirvariety, depending on one’s perspective.

Magical momentsReaching into the creative realm of pregnancy offers an

abundance of magical moments and a promising careerfocus. You can become a maternity-massage therapist,joining one of the fastest growing massage-therapyspecializations in complementary health care.

Carole Osborne is an internationally recognized instructor ofmaternity-massage therapy who has been in practice since1974. Author of Pre- and Perinatal Massage Therapy, her courseby the same name prepares therapists for maternity work. Shecontributed to Penny Simkin and Phyllis Klaus’ book, WhenSurvivors Give Birth, and to Teaching Massage Therapy. Her firstbook, Deep Tissue Sculpting, is also an established profes-sional textbook. She was the American Massage TherapyAssociation’s 2008 National Teacher of the Year. For more infor-mation, visit www.bodytherapyassociates.com.

| www.massagemag.com | October 2010 | MASSAGE Magazine | 63

FOOTNOTES

1. Gorsuch, R. and Key, M., Abnormalities of pregnancy as a functionof anxiety and life stress. Psychosomatic Medicine, 36: 1974, p. 353.

2. Goldsmith J., Childbirth Wisdom. New York: Congdon and Weed.1984.

3. Prescott, J.W., “Prevention or Therapy and the Politics of Trust:Inspiring a New Human Agenda,” Psychotherapy and PoliticsInternational, 2005;3: 194-221[l1] . DOI:10.1002/ppi.6.http://www.violence.de/prescott/politics-trust.pdf[l2].

4. Cassidy, T., Birth: The Surprising History of How We Are Born, NewYork: Atlantic Monthly Press, 2006.

5. Rosendblatt, J. and Lehman, D., “Maternal behavior of thelaboratory rat,” Maternal Behavior in Mammals. Wiley, New York, 1963,p. 14.

6. Field T., Hernandez-Reif, M., Hart, H., et al. “Pregnant womenbenefit from massage therapy,” Journal of Psychosomatic Obstetricsand Gynecology, 20 (1), March, 1999, 31-8.

7. Field, T., Diego, M.A., Hernandez-Reif, M., et al. “Massage therapyeffects on depressed pregnant women,” Journal of PsychosomaticObstetrics and Gynecology, 2004; 25:115–122.

8. Rubin, R., “Maternal Touch,” Nursing Outlook, 11/1963, p. 828-31.

9. Sommer, P., “Obstetrical patients’ anxiety during transition of laborand the nursing intervention of touch [doctoral dissertation].” TexasWomen’s University, Dallas, Texas, 1979.

10. Field, T., Hernandez-Reif, M., Taylor, S., et al. “Labor pain isreduced by massage therapy,” Journal of Psychosomatic Obstetricsand Gynecology 1997; 18:286-91.

11. Klaus, M., Kennell, J., Klaus, P., The Doula Book: How a TrainedLabor Companion Can Help You Have a Shorter, Easier, and HealthierBirth. New York: [l3] DeCapo Press, 2002.

12. Osborne, C., Pre- and Perinatal Massage Therapy: Survey ofMassage Therapists, completed June 2009. Accessed atwww.bodytherapyassociates.com.

Read “How Massage Oils Benefit Pregnant Women,”by Native Remedies’ George Luntz, atwww.massagemag.com/oilspregnancy.