Is it safe to perform Pregnancy Massage in Prone position? By Keturah Stoltenberg
As a Remedial Massage Therapist, specialising in Pregnancy, Birth & Postnatal Massage, I am often asked whether I have the table that includes the ‘cut out’ hole so that a pregnant woman can lie with her belly suspended in the prone position.
When working with a pregnant woman, in any capacity, the wellbeing, care and safety of the mother and the baby always remains the primary concern.
While I understand that it may seem appealing to lie in this position, especially if the woman is a ‘tummy sleeper’, we need to carefully consider whether prone position will negatively impact the health of the mother or baby.
To answer whether it is safe for a pregnant woman to be placed in a prone position, we first need to understand what is happening to her body physiologically and functionally.
Some of the changes that a pregnant woman may experience to her musculoskeletal system are:
- A shortened Psoas muscle pulling on the anterior lumbar spine.
- The Quadratus Lumborum muscle and Erector Spinae group, including the Multifidus muscles, decrease the space between the vertebrae, pulling them tighter and increasing Lumbar Lordosis. In late pregnancy, this Lordosis reaches its peak as it can no longer keep its integrity as the centre of gravity moves further forward.
- The Lumbosacral junction is compressed and anteriorly displaced, the Sacroiliac joints are rotated and strain on the Sacrouterine ligament increases.
- Rectus and Transverse Abdominis are in constant stretch from the growing (and weakening) abdomen.
- The Gluteal muscles that usually help stabilise the pelvis continue to medially rotate the hip and cause further Lumbar Lordosis due to the growing abdomen.
- Hip Flexors, Iliacus, Tensor Fasciae Latae, Sartorius, Rectus Femoris and quadriceps shorten as the pelvis rolls forward toward them.
- The Hamstrings are in constant stretch, weakening and decreasing their ability to stabilise the pelvis.
As we observe these Musculoskeletal Postural Changes and the impact that they have on the pregnant woman’s body, we must consider client positioning carefully to ensure the best treatment outcome.
Some pregnant women may prefer to sleep in a semi-prone position with pillow supports throughout the first and part of second trimester of pregnancy. This may feel like a safe and comfortable resting position, however once pressure is applied during massage, this is no longer a reliably safe position.
Prone positioning on a flat table may put strain on the lumbar, pelvic and uterine structures. As these muscle groups are already posturally and physiologically compromised due to pregnancy, it may not be appropriate to put further strain on these areas.
If a pregnant woman is experiencing lumbar and/or pelvic pain lying in the prone position may aggravate the causes of her pain so in my treatment it is usually recommended that this position is avoided.
It is tempting to believe resolving this concern can be achieved by placing pillows under the chest and pelvic girdle to accommodate the pregnant belly and take some strain off the lumbar area, or by using a specially designed body cushion. But is this a safe solution?
Any variation of prone positioning for a woman who is beyond her first trimester of pregnancy is placing further strain on uterine ligaments, especially the Sacrouterine Ligament, and potentially creating increased intrauterine pressure when massage pressure is placed on the posterior structures. Other factors to take into consideration as to whether prone positioning is inappropriate include placing added pressure on breasts that are already tender, sensitive, and possibly leaky.
Pregnant women can also tend to have increased mucous production and find the prone position further congests their sinus passages. This is a common discomfort for non-pregnant Remedial Massage clients and more exaggerated for pregnant women.
From my extensive training post diploma when treating a pregnant woman in her second or third trimester with massage, the safest positions to put her in are a side-lying position, or a semi reclined position. These positions are safe, comfortable and allow excellent access to the Massage Therapist to access all the key muscle groups in which the pregnant woman is likely to need treatment.
Pregnant women must make the call for themselves on the position that feels right for them and advise their practitioner accordingly.
About the author:
Keturah Stoltenberg has been a qualified Remedial Massage Therapist since 2004, and has a special interest in Woman’s Health.
She has extensive Post-graduate training, skills and experience in Pregnancy, Birth & Postnatal Massage, and is passionate about Maternal Health, at every stage.
Keturah believes in Continuity of Care as a way of truly understanding and facilitating a woman’s needs.
She offers this with multidisciplinary skills which support and nurture a woman from pre-pregnancy right through to birth and Postpartum.
Keturah is a Certified Birth and Postpartum Doula and well as a Baby Massage Instructor.
She is a mother of two teenage boys and her practice is based in the Inner West of Sydney.
You can find out more about Keturah’s work by visiting her website: www.pregnancybirthmassage.com.au