Massage therapy can be of great benefit in pregnancy as it helps to relieve some of the discomforts associated with postural changes and additional weight. It also helps to maintain good overall function of the body and provides relaxation and emotional support.

Relaxation :Anxiety is not usually an antenatal feature but should there be any apprehension associated with the pregnancy or any mood swings, massage is an excellent way of providing relaxation and support. It there happens to be stress that is related to psychosocial factors, massage can likewise be of benefit.

Relaxation techniques can be applied through out pregnancy and it is worth bearing in mind that the calming effect of massage can also be seen as extending to the baby in utero.

The sedating effect of massage helps with rest and relaxation and in turn lowers the levels of catecholamine. There compounds can interfere with oxytocin and other hormones during labour and they can also affect the baby in uterus if they pass thorough the placenta.

Massage can play a significant role, particularly during the later months of pregnancy, in alleviating pain in the lumbar area. In some cases, sciatica, which is often connected with tightness of the lumbar muscles and or of the piriformis muscle can likewise, is eased with massage.

During pregnancy the body increases its producing of progesterone which may in turn cause hypotonicity in the peripheral blood vessels and consequently lead to a sluggish circulation, oedema and varicose veins. The circulation can be impaired further by the pressure of the uterine weight on the pelvic vessels. With a slow venous return in the iliac, femoral and saphenous veins the body’s susceptibility to blood clot formation is raised. Blood clot formation increases out to five times during pregnancy while fibrinolytic activity decreases dramatically to avoid haemorrhaging during child birth.

Another benefit of massage is the improved function of organs. An enhanced liver function, for instance, leads to the elimination of toxins through the expelled bile and subsequently to an elevation of the energy levels. Unless there is eclampsia the normal levels of toxins released by the liver are not likely to cause systemic toxaemia and therefore massage is safe.

Reduced peristaltic activity and constipation are often present during pregnancy. As pressure on the abdomen is best avoided, the massage treatment for improving peristalsis is applied by means of the stroking movement on reflex areas to the digestive system; these include the thighs, the buttocks and the feet.

While massage is beneficial and effective throughout pregnancy it can easily become contraindicate if certain disorders or complications arise, e.g. symphysis pubis dysfunction where massage is specifically ruled out in the pelvic area.

It is an essential precaution that massag is carried out without causing pain to the expectant woman. Adrenal stress hormones, released as a response to pain, have the effect of elevating blood pressure, respiration rate and heart rate, the immune function is also lowered and blood flow to the uterus is impaired. It is easy to imagine how the same negative effects of the stress hormones can also diffuse into the fetal circulation through the placenta.

Massage on the pregnant abdomen is avoided other than very superficially for the purpose of applying cream or lotions. Abdominal massage is totally contraindicated if the linea Alba is strained, because of the increase pressure on the interior abdominal wall by pregnant uterus.

Compression is also avoided in the inguinal region as it can generate pressure on the iliac and femoral veins.

Systemic massages also contraindicated if complications arise during the pregnancy, particularly when there is a risk of increased intrauterine pressure. A case in point is an abnormality of the placenta i.e. Detachment of dysfunction or irregularities in the uterus or cervix.

Equally significant are disorders that can influence the blood supply to the fetus, such as high blood pressure and multiple fetuses.

Pain in the abdomen that is not related to the later stage of pregnancy and therefore to cramps or contractions, may have some underlying etiology that required investigations. Massage is therefore contraindicated until a dignaosis is carried out.

Eclapmsia is another contraindication to massage. This condition refers to sever toxaemia of pregnancy accompanied by high blood pressure, albuminuria, oliguria, tonic and clonic convulsions and coma. A very gentle and short massage for relaxation may be possible with the aim of reducing the high blood pressured.

This is best carried out to the upper arm and shoulder, for examples and with the patient in sitting positions, oedema does present in the lower limbs, but this is more likely to be a result of kidney and liver failure than lymphatic blockage. In any event, owing to the seriousness of the condition is it is best to avoid any drainage massage movement on the legs.

During the middle and later months of pregnancy, massage with the subject lying supine is best avoided as the weight of the fetus presses on the major blood vessels such as the inferior venecava. If the supine position is the only feasible option then cushion and bolsters may be used to prop up the subject in a semi-sitting posture. This reduces the pressure on the abdominal vessels and allows for massage to certain regions such as the lower limbs.

Massage in the prone position should be avoided after the twelth week of gestation or much earlier in the case of multiple fetuses. Even with the use of special cushions or equipments, the position may increase the intrauterine pressure and will inevitably intensify the tension on the over strained uterine and lumbar ligaments.

Persistent or severe backache may need referral to a manipulation therapist, such as an osteopath, physiotherapist. In some case, pain is felt in the lower abdomen, the public area, the groin or radiating down the inner thighs. This type of pain is usually made worse by walking or climbing stairs and is likely to be that of diastases symphysis pubis (DSP) or Symphysis pubis dysfunction (SPD). DSP and SPD are two conditions of pregnancy which certainly require the attempt of a doctor or manipulative therapist. Fortunately these conditions only affect a small proportion of women.

In early preganancy, usually the first three months many hormonal and physiological changes are taking place in the body.

Massage is unlikely to harm the fetus or disturb the natural processes. However being such a delicate and important time for the expectantly mother and bearing in mind that miscarriage is most common during the first trimester, it is advisable that any possible complications are avoided. Low backach or pelvic pain may be one of the symptoms of spontaneous abortion and must not be mistaken for simple muscular ache. Consequently lumbar massage for back pain is contraindicated.

Massage on the abdominal area is certainly not recommended during first trimester. Care may also be needed while there is still morning sickness or vomiting, relaxing massage movement are otherwise of benefit.

Failing to exercise can lead to an increased risk of complications during pregnancy and labour, gestational diabetes and a longer labour with increased risk of surgical intervention. Low back pain and other common complaints are more prevalent in sedentary pregnant women, and weight control can be significantly more difficult.

The continuation of exercise right through to babies birth is encouraged in the absence of serious complications, because the benefits of exercise are reversible over time, so ceasing exercise early can mean that the benefits are lost by the time the baby arrives.