• Elizabeth Hart, LMT

Advice from a Pregnant Massage Therapist

There is no denying that pregnancy, in all the glory of its amazing process, can really affect your day to day in difficult ways. Pregnancy truly is an incredible event; you’re growing a human!


But there will be days that you just don’t feel your best. From nausea, lack of sleep, cramping, hemorrhoids, headaches, back pain, etc. and now the added stress and dangers of the COVID-19 pandemic. Pregnancy during this time can be stressful, scary, uncertain and confusing- on top of normal pregnancy symptoms.

I became pregnant right in the beginning of the pandemic. I wanted to take this opportunity to share some coping methods that have helped me during this crazy, wild, scary and amazing time.


The following articles highlight how Prenatal Massage, Breath-work, Yoga, Exercise and Stretching has helped me with sleep, stress reduction, pain management and headaches through my pregnancy.


Prenatal Massage

With increased protocols and policies in place, I highly recommend prenatal massage for pain reduction, decreasing stress and providing comfort. Please talk to you Doctor first- depending on your personal history, profession/public exposure, risk factors, etc, your Doctor may or may not recommend prenatal massage, especially during this current time of COVID-19.


If they approve, Prenatal Massage focuses on the special needs of the pregnant person as their body goes through physical and emotional changes during pregnancy. Massage can help decrease stress hormones, reduce muscle tension and headaches, help support quality sleep, among other aids.


You can read further on the benefits of receiving a massage from a certified prenatal massage therapist here. With permission from my OB/Gyn, at their recommendation of waiting until I was 10 weeks pregnant (because of COVID-19) and having increased PPE/Cleaning protocols in place, I have been receiving massage every 2-3 weeks.


I have found it has helped greatly with neck and shoulder tension, decreased the severity of headaches and has helped with lower back pain. The ligaments in your body naturally become softer and stretch to prepare you for labor, which puts strain on the joints of your lower back and pelvis- hence causing lower back pain as a common pregnancy symptom!


At the time of me writing this, I am in my 6th month or pregnancy, and we have resumed massage at Integrity Chiropractic due to the safety measures we have put in place, which go above and beyond many of the CDC guidelines to give me and other expecting mothers as much peace of mind as possible. You can read about them here.


Sleep During Pregnancy

Sleep is a necessity. It is our body’s time to heal and reset. During early pregnancy, levels of the hormone progesterone increase, and your metabolism is running high.


This can cause daytime sleepiness and fatigue- if you have the opportunity to nap, try to take advantage of it. But sometimes trying to go to sleep during your pregnancy can activate restless legs, back aches, frequent urination, heartburn, shortness of breath and anxiety.


I have followed these recommendations from The Mayo Clinic and have found them helpful when trying to both fall asleep and stay asleep:


Set the Scene to Encourage Sleep

  • A dark, quiet and relaxing environment. White noise can help drown out exterior noises and black out curtains can help reduce light pollution in your bedrooms.

  • A comfortable temperature.

  • Going to bed and getting up at the same time each day might improve your sleep health.

  • Remove electronic devices from your bedroom.

  • Preventing heartburn: Sleeping on your left side with your head elevated can ease heartburn symptoms at night. During the day, try eating small, frequent meals. Avoid eating three hours before bedtime.

  • Practice relaxation techniques:  Guided meditations, deep/focused breath-work or practicing a relaxing prenatal/restorative yoga sequence are possible techniques to try. Doing them before bedtime might be helpful.

  • Keep active. Regular physical activity and exercise during pregnancy may help you fall asleep more easily.


Supportive Sleep Pillows

My added suggestion would be to use pillows to prop yourself into the positions that are the most supportive and comfortable to you (which can change from day to day). I recommend this pregnancy pillow, due to being able to remove and rearrange sections for maximum comfort.


What is comfortable will change from night to night. Honestly, much of my pillow fort ends up on the floor by morning, but at least I am cozy while trying to fall asleep. That is half the battle, isn’t it?


Stress Reduction

There is no escaping it; stress is a part of our everyday life. From managing time, pressure from deadlines, to hitting the brakes to avoid an accident, our bodies are ready to activate the 'Fight or Flight' response.


However, when there's never any relief from stress, this sustained response can be problematic leading to headaches, elevated blood pressure, stomach problems, and difficulty sleeping.


Stress can also lead to developmental problems for the fetus such as ADHD and even impaired cognitive development. That’s why it’s so important that you keep chronic stress to a minimum, for your health and your baby’s health.

There are a variety of coping mechanisms for pregnant women to utilize which can effectively counteract the effects of stress. I have found breath-work, sleep and exercise to be the most effective stress-reducers that have worked for me during my pregnancy. Here are some tips/research supporting these methods:


Breath-Work

Concentrate on your breathing. Stress can have a significant effect on the quality of your breath. It can cause you to take shallower, shorter breaths, therefore decreasing oxygen in your body.


Shallow breathing causes your stress levels to rise even higher as your body reacts to the lack of oxygen. When you feel yourself getting stressed and your breathing is affected, try sitting or lying down, close your eyes, and take at least five deep breaths.


Breathe in through your nose and out through your mouth while paying attention to the rise and fall of your chest. As you breathe, try to focus on slowing and deepening your breaths. If you need more than 5 breaths, keep going until you feel your body start to relax a bit.


I personally employ a yoga breathing technique called Nadi Shodhana Pranayama, or Alternate Nostril breathing.


Here is the process step by step:

  1. Sit in a comfortable seat and bring your right hand up close to your face. Fold down your pointer and middle finger, making what is in yoga called Mrigi Mudra (pictured here).

  2. Gently close your right nostril with your thumb. Inhale through your left nostril, then close the left nostril with your ring/little fingers. Release the thumb to open the right nostril and exhale slowly through the right nostril.

  3. Keep the right nostril open, inhale, then close it, and open and exhale slowly through the left. This is one cycle. Repeat 3 to 5 times, then release the hand mudra and go back to normal breathing


The following is a great video from ‘Yoga With Adrienne’ that demonstrates how to effectively perform this breath work.


Get More Sleep to Reduce Stress

I cannot emphasize the power of sleep on the body. As you have already read above, it is the ultimate reset button for your body and mind. I won’t repeat the details listed in the section above, but here is what sleep experts Scott Bonvallet, MD, FCCP, DABSM, and Reuben Walia, MD, with Overlake Clinics Sleep Medicine say about how stress affects sleep, especially during the COVID-19 pandemic.


“Stress can affect our sleep in a lot of ways. One is that we ruminate and worry about things, particularly when we're not distracted by work or kids. So, when people go to bed, they're not as distracted and that's when they start worrying more. That can affect our ability to get to sleep and even stay asleep.” - Dr. Bonvallet


“The COVID-19 pandemic obviously has thrown a lot of stress at a lot of people very quickly—whether it's job security, worrying about being infected or affecting family members—so a lot of people are pretty stressed out about those things. Stress can cause an increase in the hormone cortisol, which plays a role in our fight-or-flight reaction. As elevated cortisol levels stay in our body, they can disrupt our sleep patterns and our ability to get that deep, good quality, restorative sleep.” - Dr. Walia  


I repeat- more sleep! Reference the section above for techniques on reducing stress to allow for better sleep to come


Move Your Body to Reduce Stress

Exercise produces feel good hormones and can aid in burning off the feelings of excess stress and anxiety. As long as you’re having a healthy, normal pregnancy and are cleared by your doctor to do so, exercise is a great way to stay mentally and physically healthy during your pregnancy. BUT ALWAYS CONSULT WITH YOUR HEALTHCARE PROVIDER FIRST.


If cleared to exercise, here are a few suggested exercises to try:


Prenatal Yoga

Prenatal yoga is a great way to move your body to increase flexibility, strength and endurance for the muscles needed to prepare for childbirth. It can help decrease lower back and hip pain, improve sleep and reduce stress and anxiety.


The International Journal of Gynecology and Obstetrics published a study in December 2008, studying the effects of an integrated yoga practice on both perceived stress and measured autonomic response in healthy pregnant women. In a group of 122 healthy pregnant participants, the study showed that perceived stress decreased by 31.57% in a group of 45 women that practiced one hour of yoga per day (Satyapriya, 2009)


I have recently also became a Registered Yoga Teacher. Check out my video for a prenatal yoga sequence I put together:


Low Impact Aerobics

Low impact body movements carry little risk of injury and benefit your entire body. They increase cardiovascular output, build stamina, can improve the pain associated with the postural changes of pregnancy and relieve stress.


The American Pregnancy Association cites that babies are surrounded by fluid in the amniotic sac, inside the uterus, which is also surrounded by organs and muscles inside your body, creating a fairly safe environment for your developing baby. However, high impact exercises can increase the risk of falling, impact/trauma to the abdomen, excessive strain on joints and ligaments and/or exercising to the point of exhaustion. Therefore, lower impact movements are recommended.


Here is a link to a low-impact aerobic workout targeting your butt, thighs, legs and shoulders. No equipment required!


Here is more supporting research on the psychological benefits of exercise during pregnancy:


In a study done in 2008 compared the perceptions of body image and psychological well‐being between exercising and non‐exercising pregnant women, 65 pregnant women, age ranging between 23-39 years old, were split into two groups of exercisers and non-exercisers.  A self‐report exercise history questionnaire and a 10 item Body Cathexis Scale were completed on two occasions during the pregnancy, at approximately 17 weeks and 30 weeks of gestation as well as a General Health Questionnaire administered in late pregnancy.


The study found that there were significant differences between the exercise group and the non‐exercise group in late pregnancy for some items on the Body Cathexis Scale. The exercise group had a lower level of probable cathexis on the final health Questionnaire, with reduced frequency of anxiety and insomnia symptoms, and a higher level of psychological well‐being.

(Astbury, Goodwin, McMeeken, 2008)


Marci Lobel is the director of the Stress and Reproduction Lab at Stony Brook University in New York. Lobel has launched a global study on how the pandemic is affecting pregnant women. It will follow women and babies for several years, tracking birth outcomes as well as hormone levels. Although we do not have the results of this specific study yet, there is no denying that:

  • There is an increase in stress caused by the Pandemic

  • Stress has a negative effect on both mom and baby

  • It is very difficult to be pregnant right now and not feel some sort of added stress

Lobel states, “During this period of the pandemic, we are all experiencing a high level of stress. What matters is how we respond to it.


Pregnancy Headache Relief

Myself, with many others out there, am a headache sufferer. Headaches are a very common discomfort experienced during pregnancy, and may occur at any time, but they tend to be most common during the first and third trimesters.


During the first trimester, your body experiences a surge of hormones and an increase in blood volume, causing more frequent or intense headaches. These headaches may be further aggravated by poor posture and/or stress. Always check with your doctor, especially if there may be a need for medical attention.


For additional home-care techniques to try, I have done the following to help aid in reducing my pregnancy headaches:


Acupressure Mat for Headache Relief

Acupressure mats are designed to produce similar results as acupressure massage. From Traditional Chinese Medicine (TCM), acupressure is a technique used to release blocked energy (or chi/Qi) throughout the body. Removing these blockages may reduce or completely alleviate pain.


Acupressure mats contain several hundred plastic points which apply pressure to many acupressure points in the back. These plastic points stimulate pressure points along the meridians of the body according to TCM. Acupressure mats are often accompanied by acupressure pillows which can be used on the neck, head, to rest your arms, hands or legs on.


Although initially uncomfortable to lay upon, they become more comfortable as the body warms up. They may take some getting used to, but laying the mat on a soft service like a bed or while wearing an extra layer over your skin may help you get used to the feeling. It is not recommended for people with poor circulation, diabetes or other medical conditions that may impact blood pressure, durability of your skin, or if you have open wounds or infection.


Although Acupressure mats haven’t been studied extensively, one study done by Claudia Hohmann highlights the mechanical response the body has to acupressure mat stimulation:


“…due to the intense mechanical stimulation of the skin, the subcutaneous tissue, and muscles induced by the needle stimulation, it can be speculated that its mode of action is similar to other complementary and alternative medicine (CAM) manual and physical therapies, namely, via direct mechanical stimulation of the skin and the subcutaneous tissue . The NSP likely activates skin mechanoreceptors and even nociceptors, a process that might affect the transmission and processing of sensory information to the spinal and supraspinal level… The needle stimulation pad revealed a substantial potential for the alleviation of chronic NP (neck pain) and BP (back pain). Furthermore, psychophysical data support the assumption that the pad reveals its effects at least partly on a subcortical level of the pain processing system. A further benefit of the device is the fact that it is easy to use, safe, and does not require a therapist.” (Hohmann, 2012).


There is conflicting evidence to suggest that applying pressure to certain acupressure points (hands, feet and possibly lower torso) can induce labor, therefore I would recommend speaking to your doctor as well before you try it during your pregnancy.


I have used the pillow under my neck when fighting a headache and have found it very helpful in reducing my symptoms.


If you are experiencing headaches (and/or back or body pain) acupressure mats and pillows may be worth a try.



Neck/Upper Back/Shoulder Stretches

Stretching is a great way to decrease muscle tension in the neck, shoulder and upper back, which may be placing added strain on your upper body and contributing to your headaches. The following are a series of stretches focusing on decreasing tension in these problem areas.


Posterior Shoulder/Rhomboids Across Body Arm Stretch

• Take one arm and move it across your chest, moving the elbow toward the opposite shoulder.

• Use your other hand to press the elbow closer to your body.

• Hold for 30-60 seconds and repeat on opposite side.


This movement stretches your posterior rotator cuff, posterior deltoid and posterior joint capsule



Post Shoulder/Rhomboids Doorway Stretch

• Stand in a doorjamb.

• Hold onto the doorjamb with your fingers, with your arms crossed at the wrist.

• Actively spread your shoulder blades apart and sink your sternum/breast bone into your body by leaning back. You should feel the stretch between the shoulder blades.

• Hold for 30-60 seconds and repeat 3-4x.



Anterior Shoulder/Chest in Doorway

• Stand in a doorway with hands and arms out to the side as shown in picture. Keep forearms flat on door frame.

• Either keep feet flat on the ground under hips (pictured) or step forward with one leg

• Lean forward with your torso. You should feel a comfortable stretch across your chest.

• Hold that position for 30-60 seconds. Repeat 3 times. Perform 2 times per day.



Anterior Shoulder/Chest, One Arm in Doorway

• Make a “goal post” with one arm and place your forearm against a door frame.

• Turn your head and body away from the engaged arm while actively pressing your arm into the frame.

• Hold for 30-60 seconds and repeat 2-3x on each side.

You should feel a deep stretch across the shoulder and chest.



Anterior Shoulder/Chest and Forward Fold

• While standing, clasp your hands behind you at your lower back. You can also grasp the ends of a strap, towel or rope.

• Straighten spine, push shoulders down and pull your hands down away from your lower back. Think about trying to straighten your elbows while dropping your shoulders down away from your ears.

• Hold for 30-60 seconds. Repeat 2-3 times.

• To deepen this stretch, hinge forward at the waist and gently raise arms off lower back, if possible.

•Do not wrench your shoulders forward. If this is too much, back off from lifting your clasped hands and leave them resting on your lower back while still hinged forward.

• Hold for 30-60 seconds. Repeat 2-3 times.


Head and Neck: Ear to Shoulder

• Gently bring ear toward shoulder in lateral plane.

• Do not lift shoulder up to meet the ear, but slowly tilt ear toward the shoulder.

• Hold for 30 seconds to 1 minute. Repeat on the opposite side, 3-4 sets each side.

You can also passively stretch the neck by using your hand for traction on the head


Head/Neck: Seated Neck Release


This gentle stretch targets the sides of your neck.

• Sit in a chair with your feet flat on the ground. Extend your right arm along the right side of the chair (if the stretch becomes too intense, you can rest your hand on your thigh).

• Place your left hand on the top of your head and slowly tilt your head to the left. Apply gentle pressure with your hand to increase the stretch.

• To feel a deeper stretch, you can hold onto your right knee or the seat of the chair. This stabilizes the torso and allows you to isolate the stretch on the side of your neck.

• Hold on this side for 30-60 seconds, then slowly lift your head up and repeat this stretch on the other side.


Head/Neck: Suboccipital Group

• Hook your fingers into the back of your skull.

• Tilt your head, using the hooked hand to pull your head forward and down.

• Hold stretch 30-60 seconds. Repeat 2-3x, then repeat on opposite side.


Levator Scapula


• Place hand over head and hook your fingers into the back of your skull.

• Place opposite hand behind you, resting on the small of your back. Look in the opposite direction of the arm behind you.

• Using the hooked hand, pull and tilt your head so that your chin tilts toward your shoulder. • Hold stretch 30-60 sec, at varying angles.



How To Relieve Round Ligament Pain during Pregnancy

Ouch. Round ligament pain is very uncomfortable and is triggered by your expanding uterus putting pressure on the round ligaments that support it. Mine began with lower back pain on my right side that gradually made its way to my right anterior hip.


Sometimes it feels like a dull ache that gradually gets worse, and sometimes it feels like an intense, one-sided cramp. For some women it can be quick and jabby, for others (myself included) it comes on in 15-30 min episodes.


If you have ruled out other possible issues with your doctor and what you’re experiencing has been identified as round ligament pain, the following methods may help relieve your symptoms:


Move

Albeit uncomfortable, I found that simply walking around can help decrease muscle spasm to this area. Swimming also is a gentle yet effective strengthening cardio during pregnancy and the water helps to relieve pressure on the round ligaments.


Certain pelvic exercises help to strengthen the abdominal muscles and keep the uterus, pelvis and baby in proper alignment, helping to ease round ligament pain. I have found rotating in circular motions while sitting on a ball helps to gently stretch the ligaments and decrease pain. You can also perform pelvic tilts.


To do this, follow these steps:

  • Inhale as you take a seat on an exercise ball with your feet shoulder-width apart.

  • Exhale and tuck your tailbone under you, rolling slightly forward on the ball.

  • Inhale as you press your tailbone back to roll the ball away from your feet and back to a neutral position.


Cat/Cow is also one of the best yoga poses for moving baby into a favorable position for birth. It releases back tension, increases spine flexibility and strength.


  • Start on your hands and knees with your wrists directly under your shoulders, and your knees directly under your hips. Point your fingertips to the top of your mat. Place your shins and knees hip-width apart. Center your head in a neutral position and soften your gaze downward.

  • Begin by moving into Cow Pose: Inhale as you drop your belly towards the mat. Lift your chin and chest, and gaze up toward the ceiling.

  • Broaden across your shoulder blades and draw your shoulders away from your ears.

  • Next, move into Cat Pose: As you exhale, draw your belly to your spine and round your back toward the ceiling. The pose should look like a cat stretching its back.

  • Release the top of your head toward the floor, but don't force your chin to your chest.

  • Inhale, coming back into Cow Pose, and then exhale as you return to Cat Pose.

  • Repeat as many times as desired, changing position with your breathing.


Rest

Your body may be overtaxed and round ligament pain can be triggered by overexertion. Laying on your left side and placing a pillow between your knees to keep the pelvis aligned can help decrease pressure on the round ligaments. You can use another pillow under your stomach if needed as well, and/or draw your knees up to the chest also helps to reduce strain on the ligaments (Howland).


Belly Band

A maternity belt/band/splint can help to relieve some of pressure being places on the round ligaments as the baby grows. There are many different styles to choose from, and some are more supportive than others. Opt for a style that best fits your body type and needs.


This is what I use: Belly Bandit



Conclusion: Massage Therapy for Pregnancy Discomfort Relief

If you are going through a pregnancy and not feeling your best, you’re not alone.

Hopefully this article can help provide you with helpful information, based on how I have personally coped through this journey. Perhaps Prenatal Massage, breath-work, Yoga, exercise and stretching can assist with sleep, stress reduction, pain management and headaches through your pregnancy as well. If you're seeking a certified pre-natal massage therapist in Kirkland, don't hesitate to book online today!



References

“Sleep During Pregnancy” https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/sleep-during-pregnancy/art-20043827.


Walia, Reuben and Bonvallet, Scott. “Has the Pandemic Affected Your Sleep?” 4, Aug. 2020.https://www.overlakehospital.org/blog/has-pandemic-affected-your-sleep?utm_source=Healthy%20Outlook%20Blog%20Email%20Send&utm_medium=email&utm_campaign=Healthy%20Outlook%20Blog%20Email%20Issue%2038&utm_content=Pandemic%20and%20sleep


Satyapriya, Maharana “Effect of integrated yoga on stress and heart rate variability in pregnant women.” International Journal of Gynecology & Obstetrics. Volume 104, Issue 3, March 2009, Pages 218-222. https://www.sciencedirect.com/science/article/abs/pii/S0020729208005158


“Exercise During Pregnancy.” (https://americanpregnancy.org/health-fitness/exercise-during-pregnancy-5451.


Astbury, Jill. Goodwin, Ann. McMeeken, Joan. “Body image and psychological well‐being in pregnancy. A comparison of exercisers and non‐exercisers.” Obstetrics and Gynocology. 13 February 2008


Lobel, Marci. “Cope Study- COVID19 Pregnancy Experiences.” https://www.facebook.com/copestudy/


Claudia Hohmann, Isabella Ullrich, Romy Lauche, Kyung-Eun Choi, Rainer Lüdtke, Roman Rolke, Holger Cramer, Felix Joyonto Saha, Thomas Rampp, Andreas Michalsen, Jost Langhorst, Gustav Dobos, Frauke Musial, "The Benefit of a Mechanical Needle Stimulation Pad in Patients with Chronic Neck and Lower Back Pain: Two Randomized Controlled Pilot Studies", Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 753583, 11 pages, 2012.


Howland, Genevieve. “11 Natural Remedies for Relieving Round Ligament Pain.” Mama Natural. 7, Aug. 2020. https://www.mamanatural.com/round-ligament-pain/


“How to Relieve Round Ligament Pain.” Dear Darby, Blog. https://www.deardarby.com/blogs/noticias/how-to-relieve-your-round-ligament-pain.


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Integrity Chiropractic

11319 NE 120th St.

Kirkland, WA 98034

425.298.0665