Pregnancy Massage Course Handbook

Course Information

Welcome

Dear course member,

This is your guide to supplement your practical course.

You can read it before, during or after the course as a reference for what is covered in the face-to-face lessons, and it provides more detail than what is covered in class.

 

© Content is protected by Devon Collier t/a Lake District School of Massage. Copying and pasting is forbidden.

School Policies

Respect
The school has a zero tolerance policy on inappropriate comments or actions including those related to age, gender identity, ethnicity, religion, sexuality, physical or mental ability, learning styles, or other. Such comments or actions can result in suspension from the course without a refund. To avoid such incidents, please think before you speak and treat the teacher/ other staff/ students with respect at all times.

Confidentiality: please respect your classmates by not sharing their information and sensitive information they may disclose to you.

Safety
Any harmful actions whether verbal or physical experienced on the course by any student or staff member are to be reported immediately to the teacher.

The teacher may refuse your acceptance on the course if you are not well enough to attend, based on the questions and answers from the Learner Intake Form.
If you are unwell at the start or during the course, in a way which might seriously affect your learning, or other learners (such as having a contagious virus), the teacher can refuse your right to attend. A refund will not be issued, but you may attend a future course subject to availability.
Best practice: communicate with the teacher as soon as you begin to feel unwell before the course starts so that your place can be filled.

It is your responsibility to decide if you are fit and well enough to complete a massage course, which is quite active in nature, but the teacher has the right to make a judgement also.

The teacher and the school are not responsible for your safety during any activities you may pursue outside of classtimes.

Any complaints are to be made in writing to the teacher, and/or school manager, or you can contact Thinktree, the course accreditation company.

Deposits, deferrals and refunds
Please refer to the below page for more information:

Your compliance with these policies will be agreed by your signature on the Learner Intake Form, where they are also listed.

Learning Outcomes
  • Understand typical health challenges pregnant women face and how to provide relief from these
  • Understand when it is safe and when it is not advised to provide a treatment for a pregnant client
  • Know which areas to massage and which areas to avoid working on with pregnant clients
  • Safely position and drape a pregnant client in the sidelying position
  • Carry out a full body treatment in the side lying position
  • Provide aftercare advice to your pregnant clients
Assessment Details

Knowledge of the theoretical topics will be continually assessed during conversation. For practical skills, after having practised the elements of the treatment on each other throughout the day, you will repeat what you have learnt by carrying out a 60 minute treatment with the teacher observing.

Massage Practice

Massage in pregnancy

Massage can be very beneficial during pregnancy. A woman’s body is going through a lot of changes and massage can help to physically and mentally adjust to these changes by relieving physical and mental tension, and pain.

Massage is not harmful during pregnancy as long as the client is positioned safely in a position that avoids pressure on the abdomen, and providing that the pressure is not too firm or vigorous, especially on contraindicated areas (see below section ‘Areas to avoid’.)

How to massage a pregnant client

Position: Clients should lie on their side with pillows to support their head, hips, ankles and bump. Ask the client to lie on their side and to straighten the lower leg, and to bend  the top leg, this helps to stabilise her position. Then place a pillow in between the knees and ankles, this raises the hip and feet to keep the joints in alignment. A pillow under the head and the abdomen ‘bump’ is also required to keep the body aligned and supported.

Speed: Keep a slow, calm speed to relax your client and to avoid shocking the nervous system.

Pressure: A light to medium pressure can be applied according to the client’s preference. Firmer pressure can be applied to tense areas in between the medial border of the scapula, but avoid a firm pressure on top of the shoulders/ trapezius area where the base of the neck meets the top of the shoulders (see ‘Areas to avoid’ below for more details).

Massage techniques

All techniques to be carried out with the client in sidelying position, using a light to medium pressure.

Grounding – Place hands on draped client to connect. Take deep breaths and encourage the client to do so.

Effleurage – Massage both sides of the back at once, then one side at a time with reinforced hands.

Reinforced hands – One hand on top of the other with wrists/arms straight, and use your body positioning to glide upwards. The same with knuckles, keep the arm very straight and avoid pressure on the downwards stroke.

Knuckles – Keep wrist straight and use other hand as a support.

Intercostals – Apply fingers to the muscles in between the ribs.

Forearm – Use the arm which is closest to the client and with the soft underbelly of the forearm, draw your forearm up wards, useful on the outer side of the leg, with gentle/light pressure. Tip: You can support your massaging arm by holding it with the other hand.

Elbow – A light elbow/forearm pressure works well on the hip/ upper glutes area, with pressure being applied over the towel.

Posture tips for massaging

Keep fluid; avoid tensing any area of your body, for example, by not clenching fists when doing forearm movements. Don’t hold your breath. Less strain= more gain!

If your hands/arms etc fatigue, check your posture is right: the power is from the feet and legs, not your back or arms. Switch to another method such as forearm.

Excellent webpage for good posture images

Massage for post pregnancy

Carrying out treatments for postpartum/post natal clients advice: in the side lying position, or when comfortable supine/prone, using extra pillows to provide comfort. Considerations; healing post birth/c-section, breast tenderness. 

Pregnancy related health

Health challenges for pregnant clients and how we can help
Nausea

Nausea is very common in the first trimester (12 weeks) of pregnancy, and can occur throughout the pregnancy. There is a condition called hyperemesis gravidarum which causes extreme, debilitating nausea throughout the pregnancy and can even result in hospitalisation. If a client is experiencing some mild nausea you can help to reduce this by using a very small amount of ginger essential oil in a diffuser. There is a point on the client’s wrist that we can press, or encourage them to press to help relieve nausea.

Acupressurepoints Fight Motion Sickness By Nausea Relief 1

Source: https://sea-band.com/blogs/blog/find-your-acupressure-points

Dizziness

Pregnant clients may experience dizziness due to changes in blood sugar and blood pressure. It can be useful to have snacks available such as fruit and nuts (be careful of allergies) which can help to stabilise blood sugar.

Anxiety

Tension and fears about a number of things is very common in pregnancy, for example, worry about the baby; there’s two months in between the 12 and 20 week scans, and the mother can worry if their baby is ok in this time. They might be worried about how they will cope with taking care of the baby and managing over responsibilities. They might have hormonal changes which affect their mood. Or they may feel alone. Massage can help to soothe the nervous system and to make the client feel supported. Listening to the client’s worries can be therapeutic. Be sure to signpost them to other support networks or professionals instead of providing advice that you are not qualified to give.

Oedema

This is the term for swelling due to water retention, common in pregnancy due to increased pressure, especially around the ankles and feet. It can be alleviated by raising the legs. Light, gentle massage strokes in the direction towards the heart can be helpful. If the client experiences sudden swelling, a lot of swelling, or swelling which has a ‘pitted’ appearance, where an indentation stays put after we press it, should contact their medical professional asap.

Pre-eclampsia

This is a condition that can occur after 20 weeks, in around 5% of women. Its symptoms are high blood pressure, oedema and protein in the urine (pregnant women will have a urine sample taken and tested very frequently throughout pregnancy at every midwife/hospital checkup). Other symptoms are headaches, vision changes, abdominal pain and weight gain. Source: https://www.healthline.com/health/pregnancy/swelling-in-pregnancy-when-to-worry#concerning-symptoms. If the client describes any of these symptoms they need to contact their medical professional asap/ go to hospital.

Back pain

There is a lot more pressure on the muscles, fascia and bones of the back during pregnancy as the body changes shape and facilitates the growth of a baby. Back pain, especially lower, is very common. Massage can help to relieve this. Swimming and safe exercise such as pregnancy pilates can really help with back pain too.

Pelvic pain

This is called PGP- pelvic girdle pain, or SPD- symphysis pubis dysfunction. This is pain due to stiffening or changes in the joints linked with the pelvic area. Walking, lifting and sitting can aggravate it. A physio/ GP can offer advice on how to reduce discomfort. This condition is not harmful to the baby. Gentle massage of the hips and lower back, alongside communicating with the client about the pressure may help. As we know, the whole body is linked, so relieving tension from the whole body can help to relieve pain in other areas. Source: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/pelvic-pain/

Tip

Be extra lenient with your pregnant clients if they need to cancel or are late for their appointment because of pregnancy related symptoms. It is wise to contact them the day before/on the day to check in.

Pregnancy related contraindications

Reasons we might not provide a treatment:

  • When the client is experiencing abdominal pain or bleeding. In this case we would advise them contacting their medical professional asap.
  • When the client is not feeling well enough (such as dizziness, strong nausea).
  • The same reasons as with your non pregnant clients (see section below ‘Additional information on client Safety’ regarding standard contraindications)

When the client has medical conditions (other than mild and medicated conditions such as hypothyroidism) or a history of miscarriages, we should ask them to contact their midwife or medical professional for approval, or we should ask for consent to do so.

Areas to avoid

Avoid applying a lot of pressure on these points. According to traditional Chinese medicine (TCM) practices, these points are related to the body releasing, for example, releasing emotions/ digestive issues, and can also help to induce labour. It is therefore best to only apply light pressure/ strokes to these areas.

Image Source: https://acuproacademy.com/acupuncture-practice-tcm-resources/

Maureen Abson in her book ‘Healing Massage’, 2016, advises to avoid massage of the inner leg during pregnancy, as well as these points illustrated below from the book.

20240419 103906 20240419 103616 20240419 103857 20240419 103852

The consultation

Once you have your client’s health consultation form and know about any possible conditions, allergies or medication, and the client is in the room prior to their appointment, all that is left to discuss is the treatment room and their treatment. Clarity is very important, especially with new clients.

Make sure they know where the facilities are, and that they can use these before, after and during their treatment if needed. Visiting the loo is more frequent in pregnancy because the baby can place pressure on the mother’s bladder, as well as the fact that the mother’s body is providing and filtering water for another person.

Explain about the room, for example, if the bed is heated and what temperature they would like.

Explain that they should freely communicate about their preferences such as the pressure of the massage, the heating or anything else.

Explain how to get on the table and how to undress, for example, keep their knickers on and place the other items out of the way. Be very clear and specific.

Additional information on client safety

The information on the below sections about consultations and contraindications is the same for any Level 3 Massage course, and what is detailed below serves as a reminder.

Contraindications

Contraindications are conditions and physical states which may be affected by massage. For example, receiving a massage whilst ill with a cold can make someone feel worse, as well as potentially pass this on to the therapist. We need to make sure that the client and therapist will be safe and not negatively affected by massage.

Asking clients for their medical history is very important to protect them. It also protects your business; if you massage someone with a precarious state of health such as a serious unmedicated condition, and then they claim that you have harmed them, it can damage your reputation or lead to legal issues.

The best way to ensure that you can treat a client is to ask them to complete a consultation form before their appointment. This can help you to work out if they are suitable for treatment. It is wise to do this at the booking stage, before the appointment date. This has the advantage of not having to turn a client away once they are in your treatment room. In addition, once they have provided you with health information including medication they take, or any conditions they have, you then have the chance to research a suitable course of action in advance.

An example to illustrate this is from a client I treated. They had listed that they have epilepsy on their consultation form. I knew that this could be a contraindication, but that there is a lot of variety with this condition. So I took the time to do some research. I searched about treating a client with epilepsy in online medical articles and found that it can be useful depending on the severity of the condition. I also searched on the Massage Warehouse’s Facebook group for other therapist’s advice. Other people who had queried this had been advised that massage can be very helpful for epilepsy and that the client should be contacted in advance to find out more about their condition. In addition, applying firm pressure to the neck area should be avoided. I messaged the client with some questions about their condition: ‘’Thank you for completing the consultation form, you have listed that you have epilepsy. Would you mind answering a few follow up questions to ensure that I can provide you with a safe and effective treatment? Is there anything that triggers seizures? Could you generally tell me a bit more about your condition, such as which type it is, how often you may experience seizures and if you know you are about to have a seizure? Do you have a contact I can call in the case of a seizure happening? I found out that the client had not had a seizure for over a decade. That  they would know in advance if they were going to have a seizure, so they could tell me and I could stop the treatment. I added their emergency contact to my phone who I could call if necessary. I also decided to research what to do if someone has a seizure.
Therefore, having this information in advance was incredibly useful to protect my client and myself. This is the level of research you should carry out prior to treating a client with contraindications.

Localised contraindications- Conditions which are localised to a specific area of the body

These include burns, bruises, varicose veins, inflammation, cuts or wounds, fractures, sprains and strains and skin conditions like eczema which only affect a certain area.

You can massage clients with these issues, except over the affected area. In most cases mild varicose veins or mild bruises can be massaged over lightly, but you need to discuss this in the treatment plan with the client to agree on a course of action. Sprains and strains: You can massage lightly over strained areas (such as a pulled muscle), avoid firmer movements until the area feels much less sore, around 3 days-2 weeks. A sprain is an overstretched or torn ligament (ligaments are connective tissue which bind bones together), wait until the pain/inflammation has subsided, then very light massage can be applied.

Whole body contraindications- Conditions and physical states which affect the whole body

These conditions mean that massage may not be suitable because treatment can make the symptoms worse. Or that special precautions need to be taken to ensure your client is kept safe.

Asthma

It is not contraindicated but with it would be worth asking your client to bring their inhaler. An easy way around asking them to do this would be to include on your consultation forms or pre -treatment advice info, that they should bring any medication or devices such as inhalers/ epipens which they need on a regular basis. It’s common sense, and it’s very likely they will already do this, but there’s no harm in over-informing clients on health and safety topics.

Blood Clots and a note on post covid

Massage can cause blood clots to move around the body and to possibly reach vital organs. Therefore, clients with current blood clots or a history of them should ask for medical approval before receiving treatment to ensure this is not a risk. If a client has had serious repercussions of covid and were hospitalised, its worth noting that there has been some links with covid and blood clots, and checking if they have a history of this and asking for medical consent.

Cancer

Clients with cancer can really benefit from massage. You do not need a specific oncology massage qualification in order to practise as long as the client is in remission*, and they are not undergoing chemotherapy. So make sure you understand as much as you can about their situation first, and if in doubt, feel free to refer them to an oncology trained massage therapist.

*Remission means that the signs and symptoms of your cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared. If you remain in complete remission for 5 years or more, some doctors may say that you are cured. Source: Article from the National Cancer Institute.

Here is a nice, clear article about breast cancer and massage. Please read it, especially if you are preparing for a treatment with someone relevant.
Some of the main messages from the article:

Areas to avoid: As a therapist you should avoid directly massaging the arm/shoulder area if your client has lymphoedema. There are specialist lymphoedema massage treatments (known as manual lymphatic drainage) which can help improve the flow of lymph fluid. If your client has had lymph nodes removed, it is best to avoid working on and close to the area. For example, for lymph nodes near the armpit, avoid massaging the arm closest to the operation site.

Comfort: If your client has any soreness or discomfort from surgery, you should provide extra cushions to protect any areas of discomfort or allow/ encourage the client to adjust their position.

Pain: Explain to your client before treatment that they need to communicate to you if they are in pain. And during the treatment, check in with your client in case they have pain in their arm or shoulder, if so, stop working on that area.

Chemotherapy and radiotherapy: If your client has recently completed treatment, ask them to check with their treatment team if it is safe for them to have a massage on the area that’s been treated.

Contagious Diseases

Although massage might be beneficial to the individuals, massage is not suitable for people with contagious diseases due to the risk of cross infection to the therapist.

Epilepsy

Massage can be very helpful for clients with epilepsy but precautions need to be taken. Ask the client if they are taking medication to control this. Ask them what the triggers are for a seizure so that you do not aggravate the condition. And make sure you have a plan of action in case of a seizure.

Fever/colds/flu

When ill with a type of fever, the body is undergoing immune responses to fight the illness. It is best to let the body heal naturally before having an appointment. Massage can exacerbate symptoms. In addition, as a therapist, you need to protect yourself from catching germs. You can always recommend your client to self massage by leaning onto tennis/ other massage balls to relieve shoulder tension whilst they wait until they are ready for an appointment.

Fibromyalgia and autoimmune diseases

Clients who experience conditions which cause them to feel pain should be treated the same as other clients, but pay extra attention to communicating about how much pressure they would like in their massage. During the verbal consultation prior to treatment, discuss a treatment plan which includes the amount of pressure they prefer, and the areas you will work on. Communication is key, so you need to check in with your client to make sure they are comfortable at various points throughout the treatment.

High blood pressure (hypertension)

High blood pressure is common, and if the condition is managed with medication, and the client is otherwise healthy overall then massage is safe. However, unmedicated clients who have (uncontrolled) high blood pressure require medical consent.

Low blood pressure (hypotension)

Massage can furthermore lower blood pressure so make sure the client feels well on the day of their appointment, for example, when you receive their consultation form you could message them to say, ‘As you have stated that you have low blood pressure, please feel free to contact me in the days leading up to your appointment or on the day if you feel unwell’.

During their appointment, pay special attention to allowing the client time to lie down or be seated for their treatment, as well as lots of time to get up. Make sure they are hydrated and encourage them to communicate with you if they feel lightheaded.

Kidney Conditions or Liver Conditions

Clients should speak with a medical professional to discuss if massage is suitable for them. Once you have approval, make sure you only massage the areas over or near these organs lightly.

Contraindications – a summary

Communication is key: speak with the client in advance of their appointment to find out more if necessary. Ask the client to get approval from a medical professional if you are in doubt. Holistic therapies can be incredibly helpful to clients experiencing pain and/or stress, providing that they are applied with care and that your client is comfortable.

Aftercare

After the treatment make sure your client has water available.

When they are dressed and you speak with them post treatment you can ask how they feel.

You can encourage them to keep hydrated and to avoid strenuous activity.

If they received any firmer pressure, such as in between the shoulder blades, you can inform them that some mild discomfort is possible the day after in the areas where firm pressure was applied.

Massage can also bring on tiredness or a cold if the client has been run down or overly busy; the body’s way of encouraging healing. It is good practice to explain about emotional release to your clients, where feelings may surface during or post treatment so they can be reassured that this is normal. Such feelings may show up as laughter, sadness/crying or intense dreams.

Another option for giving this aftercare advice is to provide your clients with this information in their booking confirmation before their treatment. This can help your client to plan their day, for example, to aim to leave the following few hours free. On many booking systems you can edit an appointment confirmation/ and or reminder email. In my practice, I prefer to provide as much information as possible. This includes: the address and parking info, what to wear, advice on not eating a heavy meal before-hand and the aftercare advice. This helps clients to prepare, especially if they are new to massage and are not sure what to do.

Your safety

Insurance

In the first instance, find out from your insurers if you are covered to treat pregnant clients. Most insurers will not cover you for claims on a pregnant client in the first 12 weeks of pregnancy (the first trimester). Massage does not have a negative affect at this stage, the reason behind the caution is that women have a higher likelihood of miscarriage during the first 12 weeks of pregnancy. So insurers want to steer clear of any cases of a woman linking a miscarriage with a massage appointment. In addition, if a pregnant client has any health conditions you should ask them to obtain medical approval, such as from a midwife or GP.

Staying safe

These things can help to prevent disrespectful people booking from appointments:

-Not having your mobile number or home address online. Instead, you can buy a virtual landline (which either looks like a local area home phone or a business line), which redirects to your mobile. It means that you won’t receive silly text messages from strange people at night! Plus it can look more professional.

-Using a booking system with prepayment: most dodgy people prefer to book by text or phone call. So having a booking system, especially one with compulsory advance payment helps to deter unreasonable people.

Policies– make sure clients read your policies (such as those related to payments and behaviour) before they book. Having those listed on your booking system with a tickbox or signature box helps.

Intuition– If something seems odd then don’t second guess yourself

Self care

If you want to sustain your career in the long term then self care is a priority. You will not be good at your job (or anything else) if you feel terrible. So self care should be viewed as a work responsibility. Massage can be like competing in athletic exercise, you need to really look after your body. Strengthening the back is a great way to avoid postural issues, such as toning the rhomboids, as well as core exercises such as pilates for posture. And after doing some massage work you will benefit from stretching out the muscles you’ve been using, in the same way that athletes stretch after a run. As well as other obvious wellbeing practices like eating whole foods, exercise and resting, it’s really important to receive lots of massages! Not only will this benefit your mind, body (and soul), but you can also pick up extra techniques or business ideas from other therapists. It all adds to your skillset. Setting up a therapy swap with another massage therapist is an amazing way to get free treatments, to practise techniques, share resources and get feedback. It’s also just a great way to talk about massage work related things too which can be useful if you work solo most of the time.

Contact