How to tell if a massage therapist REALLY does prenatal massage

So you're pregnant and have been researching ways to facilitate a healthy pregnancy and potentially lead to an easier birth experience?  If you are reading this post, you have likely come across a lot of the information about how beneficial prenatal massage is, but if you haven't here is the link to my post about it.  Unfortunately, what many of those posts don't tell you is that not all massage therapists doing prenatal massage are actually qualified to offer it.  Many establishments that offer prenatal massage are so worried about letting your money walk out the door, that they will assign you to a therapist who is not qualified rather than having you wait for someone who is.  It happened to me all the time when I was working in day spas fresh out of massage school and had very little instruction in working with pregnant people.  So, before you schedule that prenatal massage there are some questions that you may want to ask your massage therapist to find out if they are actually qualified to perform your massage.  Here are my 5 signs that your massage therapist should not be performing prenatal massage:

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1. They are not certified
You might think that figuring this out is a matter of a quick question, “Are you certified in prenatal massage?”, but unfortunately it isn’t always that simple.  I remember one point early in my career (within 2 months of graduating massage school) when a receptionist at the “high-end” Aveda spa I was working at came into the back to tell me that she had booked a prenatal massage for me.  The client had requested a therapist who was certified, but they didn’t have anyone, so they just assigned her to me and told me to tell her I was certified if she asked.  They should have known better, because I had a bit of a reputation for refusing to lie to my clients (which I was asked to do on too many occasions).  During our verbal (they don’t require written there) intake, she asked if I was certified.  I told her that I was not, but had been instructed to tell her I was.  She asked to speak to my manager, and I said “I wish you would.  I keep telling them not to book these for me, but they won’t listen.”  At the last place where I worked before opening my own practice (a popular chain), they assigned therapists based on a rotation.  This was done so that no therapist would feel that sessions were unfairly being given to one therapist over another.  I understand the idea behind the rotation system, but where they went wrong, was in using it for every type of session, even where special qualifications were needed.  At the point that I was working there, I was trained and certified to work with pregnant clients, but the majority of the prenatal massages were given to unqualified therapists simply because they were up next in the rotation, and the establishment did not want to be seen as being unfair.  There are many reasons I left working in spas to open my own practice and situations like these definitely played into that decision.

So, if the receptionists and therapists may be instructed to lie to clients, how do you find out if your massage therapist is actually certified in prenatal massage?  Ask follow up questions.  I would recommend asking who they are certified through, or when they became certified.  If they are lying to you, they are not likely to come up with an answer off the top of their heads.  Granted, I often have to take a moment to figure out how long I have been doing certain things, but I would know right away, that I am certified through Body Therapy Associates (Now Body Therapy Education) and the Carole Osborne program.  I could also easily tell you that I did the training in early 2011, I would just have to take a second to do the math (7 years).  In addition, I have a scanned copy of my completion certificate above and on my website here.

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2.  They do not have you fill out a form, or ask you questions about your pregnancy
First of all, you should never get a massage someplace where you are not asked to fill out a health history form, period.  There is a lot of information that is pertinent to our work that we wouldn’t necessarily ask about in a verbal only intake.  An intake form is someplace that I can have check boxes that ask you if you have asthma, or fibromyalgia, or migraines, where you can just check the box if you have it.  I did a whole other blog post about why we use intake forms, so check it out if you have any questions about what is on our forms.  When you are pregnant, your body is different than if you weren’t, so there are certain things I will want to ask about before I work with you.  I have an intake form with questions specific to your pregnancy.  If you are a returning client, I will ask you to fill out a brief form (pictured right) that only asks about those questions so that you do not have to fill out an entire intake again.  I will also have you fill out the same form for each subsequent pregnancy if you see me through more than one.  Not everyone will ask you to fill out a form if you are a returning client, but if you are seeing a massage therapist who you have worked with before, they should at least ask a couple of basic questions about your pregnancy such as if you have any factors that have classified this pregnancy as high risk, discomforts related to your pregnancy, and information about your care provider.  If a massage therapist is not qualified, they may not know what questions to ask.

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3.  They will not work on you if you are in your first trimester
Ok, so this doesn’t necessarily mean that the practitioner is not qualified, but is more likely a sign that the place you are going is not as clear on the precautions of working with pregnant women, which very well could be a red flag for the practitioner as well.  The reason that many establishments do not offer massage for the first trimester is for liability reasons.  An estimated 15-20% of all pregnancies ends in miscarriage, and of those miscarriages, about 80% occur during the first trimester1.  This is the same reason that many expecting parents choose not to share the news of their pregnancy until they are past the third month, especially if there has been a previous loss.  Many establishments worry that if a woman miscarries who has received a massage there, she may point to the massage as the cause of the miscarriage.  In reality, there has been no scientific (or legal) link whatsoever between therapeutic massage and miscarriage.  The way that I handle this, is to have my pregnant clients sign off that they are aware of the fact that massage does not cause miscarriage before we work together.  That way, if they were not already aware, they are now and are signing off that they are acknowledging it. 

​My recommendation before getting a massage at any point in your pregnancy is to ask whether or not they will work with you in your first trimester.  This will give you an idea as to how much the people working there know about pregnancy massage in general, and even if you are well past the first trimester, it can help you to gauge whether or not it is someplace you should go.

4.  They ask you to put your belly through a hole in the table
This topic can be a bit controversial depending on who you are talking to.  Many practitioners claim that it is perfectly safe, but as far as I am concerned, the evidence is just not there to back up that claim.  There are several issues with the so called “pregnancy tables”.  So much so that I dedicated one of my first ever blog posts to it.  It has been several years since I wrote that post, so lets do a quick run down of why these tables are dangerous. 

First of all, not all bodies are the same shape and size.  Some people have longer torsos than others, some carry higher or lower, and some people have weight distributed differently.  Therefore, having a table with a pre-made hole in it is going to fit every body as well as a one-size fits all garment.  That is to say, not well at all.  So depending on how you are built and carrying, the hole is likely to be too big (they make the holes bigger to try to accommodate more people), and may be too high or low on the table for your belly, making it uncomfortable. 

Secondly, and perhaps more importantly, putting your belly through a hole in the table can cause harm to you and/or your baby.  The uterus is held in place by 3 sets of ligaments.  During pregnancy, a hormone called Relaxin is released that causes you to not feel ligament pain as much.  This comes in handy as your pelvis starts to shift and open to allow baby to get low and eventually come out.  It also means that you are not going to feel ligament damage as it is happening.  Hanging your belly through a hole in the table essentially means that gravity is pulling the entire weight of the contents of your uterus (baby, amniotic fluid, placenta) down, while your ligaments are trying to keep everything where it is supposed to be.  This can cause great strain and damage to the uterine ligaments.  Some tables have a sling that goes underneath the table which can be tightened to support the ligaments, but the amount that it needs to be tightened to protect those ligaments is enough to increase intra-uterine pressure (the pressure inside of the uterus), which can potentially cause damage to your developing baby.  Think about placing a water filled ballon on a table and then pressing something on top of it, and what that does to the contents of the balloon. 

Third, not only can these tables cause damage to your uterine ligaments, they can also cause back injuries.  When working with a client in prone (face down position), I can safely do compressions and use various techniques all along their back because there is a stable surface underneath them to provide support.  On a table with a belly cutout, that surface is much less stable, meaning that doing work along the back is much less safe and more likely to cause injury.

There are numerous articles and blog posts about the dangers of these tables written by midwives, massage therapists, massage publications, and more2,3,4.  Unfortunately, there are a lot of places that still feel that these tables are safe.  Massage therapists who use them like them because they can essentially work the same way that they would with a non-pregnant client, but your safety should never be compromised for the convenience of someone else.  In addition, any massage therapist worth their salt is going to be comfortable working with a client in a side-lying position (pictured above).  Whatever you do, do NOT get your advice from people on message boards.  I saw a board on What To Expect that asked about the safety of these tables and there were people telling the asker that it must be safe because otherwise it would not be an option.  This is dangerous advice.  Please consult professional sources with questions about safety.

*Note:  It is generally safe to lie face down through most of your first trimester.  You can also lie flat on your back up until about 21 weeks, however after week 12, we put a small wedge under your right hip to help with positioning of the baby.  After 21 weeks, you can receive seated, side-lying, or semi-reclined.

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5.  They refuse to touch/work on your ankles or feet
There is a common misconception that it is dangerous to massage or touch a pregnant woman’s feet or ankles.  It comes from the fact that there are a few pressure points in the area that can trigger uterine contractions, and the worry is in triggering early labor or causing miscarriage.  In massage school we had very little instruction in working with pregnancy (a short lecture and a couple of days of basic side-lying work).  The amount of instruction I received in massage school in no way prepared me or qualified me to do prenatal massage.  When you have programs that skim over working with pregnancy, they often make a blanket statement about avoiding work on the feet or ankles just to be safe, and students are often told to seek continuing education after graduation if pregnant people are a population that they are interested in working with.

Here is the deal with the pressure points: Yes, there are points around the ankle (and hand and shoulder for that matter) that can be stimulated to trigger uterine contractions.  I use these points to help get a labor going, or to help contractions to become more consistent.  The way to stimulate the points is to create a pretty specific pressure and hold for a minute or so.  This is not something that most therapists do in the course of a foot massage.  Because the points there are not likely to be accidentally stimulated, it is perfectly safe for a pregnant woman to receive massage around her feet and ankles.  Anyone who has trained in prenatal massage is aware of this.  Therefore, if a therapist says they can’t work on your feet or ankles, it is a pretty good sign that they are not qualified to be working with you in the first place.

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Have you received a prenatal massage?  What was your experience like?  Share your stories or questions in the comments below!

1.  https://www.verywell.com/making-sense-of-miscarriage-statistics-2371721
2.  www.turningtidesmidwifery.com/blog/pregnancy-massage-tables-versus-positioning
3.  www.massagemag.com/pregnancy-massage-tables-think-before-you-buy-13458/
4.  www.zeel.com/blog/massage/types-of-massage/prenatal-massage-tables-and-techniques/