Post-natal massage

[Ro .]

I've taken continuing ed that covered pre-natal massage, and have worked on a number of women over the last year since. One of these clients has been a regular weekly client who I've been seeing since her 10th week (now 32 weeks along.) She's already expressed that she'd really love to have me continue working on her after her delivery (a scheduled c-section), but I informed her that I don't have any post-natal experience or additional information, but that I'd be looking into it.

My question is, how much different is post-natal massage from pre-natal? I understand that a c-section brings it's own issues, but if the client is comfortable and techniques are conservative, what kind of cautions/contraindications are of concern? I'm assuming to get her doc's ok first anyway, but what (if any) waiting period is there after delivery? I am interested in getting more in depth information on this, but can anyone give me a basic overview?

Thanks .

 

[G. #2]

when i took a pregnancy massage workshop in school, our instructor spent a lot of time talking about post-partum massage, two years following birth. i am just going to copy down some information from a handout we got.

1-3 days (after delivery)

Unless mother is in pain for specific muscle spasm (or something similar), it is unlikely massage will be needed since the normal system provides an overall narcotic effect at this time.

1-4 weeks later

The uterus healing and beginning of lactation absorbs a tremendous amount of energy, therefore deep tissue work is not advisable unless a specific muscle spasm is firing. Post-event massage techniques, Swedish, or integrative work to integrate and flush the body is helpful. REST,REST,REST... The newborn is stimulated by absolutely everything. This is a time time for mother and baby to be quietly together so mother may heal and bond, and baby may be nurtured.

1-3 months post-partum

Neck pain is the most common complaint. Educate on body mechanics related to nursing and holding the baby. Around three months, the shoulder girdle usually begins to fire constantly. Arm, shoulder, and thoracic outlet focus is very productive. Posture, movement and breathing education very important. Full body massage is very nurturing for the emotionally and physically fatigued mother. Watch for signs of post-partum depression. Not a good time to begin any structurally demanding exercise.

3-6 moths post-partum

Hip stabilization, correct abdominal strengthening techniques, body mechanics and movement education. Marital stresses and returning to work issues usually begin to influence the mother.

10-14 months post-partum

Low back pain, and mid to lower thoracic pain become predominant complaints. Ligaments are stronger but still loose. Hip stabilization, full body, and specific trigger point work is common. Mothers may begin discussing having another child. Fatigue and lack of social connection are usual complaints or concerns, especially if the mother nurses.

16-20 months post-partum

Strong urges to exercise the body, usually in structurally challenging ways. Ligaments are still soft, low back still weak and often painful, hips usually need stabilization work. Abdominal and psoas work in highly recommended. Focus needs to be on correct movement patterns and gentle cardiovascular conditioning. Many complaints of neck pain and mid to upper thoracic pain. Subscapular, latissimus dorsi, and lower trap work is very helpful.

18-24 months post-partum

The ligaments of the body are usually completely "cinched down" by two years post-birth. Perfect time to concentrate on hip stabilization, hip and low back deep tissue, adductors and quadriceps group. Ideally 2-4 deep tissue session on hips and low back, followed by a program like pilates for strengthening and conditioning will prepare the body well for the end of the post-partum period.

 

[Sarezh]

Wow. Very informative. Thanks for sharing that!

 

[Cheese is good.]

I second that notion! Thank you!

 

[Rylee]

you're welcome.

i have found this handout helpful, and have referred to it many times since it is common to start massage sessions with a new mom AFTER she has already had her baby.

the instructor we had for this workshop is a super sweet and compassionate, extremely knowledgeable lady. she emphasized the importance of the mother continuing to receive bodywork post-partum, which "facilitates structural realignment of the spine and pelvis through the rehabilitation of abdominal and psoas musculature." she also recommended a few different exercises.

one postural exercise/advice she gave is suitable for any seforum.xxxe of the pregnancy (as well as just anyone with anterior pelvic tilt):

Do all movement and stretching with the head floating like a helium balloon and the sacrum falling downward like heavy change in the back pockets. This creates a lengthening, a polarity, and a tractioning of the spine. This is an awareness we are always trying to teach our clients to improve correct body mechanics and strengthening.

 

[Pam R]

Awesome - thank you .

 

[Mc.Zee]

The instructor we had for this workshop is a super sweet and compassionate, extremely knowledgeable lady.

Does she still teach? If so, please share her name & website, if she has one. I'm sure many people would love to take her classes.

 

[Bass]

Wow!! There is some great info in this thread! Thanks ccmarie.
I am printing this one out for easy reference in the future.

 

[Shay ley ley]

Does she still teach? If so, please share her name & website, if she has one. I'm sure many people would love to take her classes.

well, she is on faculty at the school i went to. (Colorado Institute of Massage Therapy) her name is mel lake.
i am pretty sure she teaches the pregnancy workshop a couple of times each year, but i don't know if it is only for students. (also, i am not sure if she teaches continuing ed classes outside of the school.)
i will post a link to the continuing education calendar at the school. it looks like they only have classes listed through april right now, with a note stating the complete schedule to be posted by the end of january.

http://www.coimt.com/continuing-education.htm

 

[Peter & Paulo]

I would love to continue this thread with any other suggestions, but I have a question about Pre-natal massage also.

I was taught in school to lie the mother on her Right side only, so as to not compress a certian nerve, vein or artery (I can not remember the name of it for the life of me right now)
The other therapist I work with in the Chrio office will position the mother on both sides. She was taught that it was ok for short periods of time.??
What is appropriate?
Also, how do you apply deep work to a pregger client? I worked on one a bit ago, and I was hesitant to work too deeply (again we were taught to stay superficial) and I believe she was dissapointed with the service.
(I would feel more comfortable doing deeper work if I had been seeing her throughout the pregnancy, or before so I could have been more aware of her threshold.)
I just find the body mechanics are extremley difficult to work on the back in a side lying position. Any suggestions?
thanks all!
Jp

 

[geeko]

actually the caution is that you don't want the mother to be in a position which causes the uterus to put pressure on the descending aorta or inferior vena cava.

but, let me post this little blurb from a handout about side lying position:

This is an ideal position for pregnant women to receive massage. It is very safe and comfortable, and lying on the left side increases cardiac output by 22%. Many health care professionals advise pregnant women to lie only on the left side as a precaution to avoid Supine Hypotensive Syndrome; however, recent research shows that there is no other difference between left and right side lying positions. In fact, for postural reasons there is value in lying on both sides.

you can also put mother in a semi-reclined position, with the aid of wedges and pillows to bolster her up in a comfortable resting position. don't forget to bolster under right hip, and some small pillows or bolsters for arms. here is a recommended procedure:

Use a salon back table, or large wedge pillow to position her torso at a 45 to 60 degree angle with the table and add pillows as necessary to maintain proper neutral alignment and fully support the head to the low back.

Place a wedge pillow (can use "baby wedge") under her right hip to shift the weight of the uterus and baby off the descending aorta and inferior vena cava, avoiding Supine Hypotensive Syndrome which decreases the mother's blood pressure and the fetal circulation and increases pressure on the mother's venous system.

Place pillows under both knees and under both arms.

When changing positions or getting off the table, help her sit up from this position or ask her to roll onto her side and use her arms to sit up, avoiding stress on her abdominal tissues.

 

[Yeehawfreesex]

mel lake gave us so many fabulous handouts in this workshop. the most helpful is in each trimester she states what is going on with the baby, the mother, and what the therapist should focus on. i will post some of it, that i think should help to answer your question about deep tissue, PremotMT.


First Trimester
from date of late menstrual period through 13th week

BABY

From fetilized egg to 3" long
Has complete skeleton (body, arms, legs, eyes, nails and ears)
Major organs forming by 6th week, developed by 12th week
13th week placenta issues hormones which maintain pregnancy
Responds to touch

MOTHER

Ultra-sensitivities
Aches and pains usually disappear because of hormone, relaxin
Risk of miscarriage is highest
Increase in blood plasma makes anemia possible

THERAPIST FOCUS

Swedish massage main modality
Abdominal work is contraindicated
Passive joint movement or rocking may increase nausea
Avoid reflex work around lateral malleoli and anterior tibialis
Prone or supine positioning still comfortable

Second Trimester
14 weeks to 28 weeks

BABY

Grows to 11-14 inches
Heartbeat audible, fetus movement felt by mother around 18 weeks
Responds to sound

MOTHER

Uterus reaches umbilicus
Structural problems can begin (low back stress, enlarged breasts, skin stretching, muscle and ligament cramps, varicose veins and hemorrhoids, uterine ligament twinges)
Anemia possible

THERAPIST FOCUS

Wedge right hip in supine postition so the uterus does not put pressure on the inferior vena cava
Deep tissue massage is OK (keep in mind toxins released in mother's body will probably reach baby)
Intent is to relieve stresses of pregnancy and prepare for birthing

Third Trimester
29 weeks to 40 weeks

BABY

Weight doubles in 7th month
All but lungs functional by 8th month


MOTHER

Uterus reaches bottom of rib cage
Pubic symphysis, sacroiliac joint discomforts
Edema, especially in ankles and legs
Uncomfortable in one position for lengthy time
Sleep can be uncomfortable, wakefulness in early A.M. hours

THERAPIST FOCUS

Side lying and semi-reclining best positions
All massage modalities can be appropriate with intent to relieve discomforts (also will relax sympathetic nervous system and prepare for birthing)
Soft ligaments can make some passive joint movements uncomfortable; check in with client as you do it
Relief of pelvic congestion, SI joint, and low back strain
Deep tissue work on adductors in preparation for delivery

 

[Pompal 09.]

Ugh, school teachers... :roll: LOL. Thanks CC, wonderful information! I am going to look into pre, and post natal courses (along with many others LOL!) it is so wonderful to watch a woman's body change, and I would love to be more capiable to facilitate a mother through pregnancy.