You Can't Massage A Pregnant Woman's Feet - Myth or Fact?

I was recently watching an evening tv drama in which a character and his pregnant wife were in a class and the instructor said, "Time for foot massages! Now who can remember what part of the feet we completely avoid?" To which the character (a doctor) replies "The ankles". This reminded me how often I hear things like this in regards to massaging pregnant women's feet. It was nice that the show actually mentioned that foot massage is ok while pregnant, however it stated to "completely avoid" the ankles without any explanation as to why.

Not massaging a pregnant woman's feet is one of the more commonly heard "tips" when it comes to prenatal massage. Many pregnancy books and sites claim that foot massage can cause lots of problems, most commonly that it send a woman into early labor, so it is best to completely avoid it. Some statements are a little more lenient (like the tv show I was watching) and say that foot massage is ok, but with certain limitations. So what is the truth? The fact is that, like many things, somewhere there was a small grain of a fact and over time it bloomed into something that became a full-blown myth, urban legend, whatever you want to call it. So how exactly did this myth come to be?

Myth origin #1: I've mentioned this in a previous article, but one culprit here are two widely heard of, but often misunderstood, massage modalities known as acupressure and reflexology. In these types of massage, pressure is applied to a specific point on the body (acupressure) and in the feet (reflexology), and depending on where certain points are located, the points can have an effect on certain parts of the body. The fear comes that if certain reflexology points are touched, it can cause labor to start.
Facts: While acupressure and reflexology can have an effect on certain parts of the body, very specific things need to happen. In acupressure, static pressure needs to be applied directly to the specific point and held for 3-5 seconds. Not something you generally see in a gentle massage where the strokes generally keep moving. As far as reflexology goes, there are points located on either side of the heel that relate to the ovaries and uterus, as well as the fallopian tubes arching over the foot. Not exactly located in the ankles, but loosely in that general area, hence the source for the advice to avoid it. Once again though, just a gentle massage over this area is not reflexology per se, only if you specifically target this area with direct and sustained pressure. Another reason "ankles" may be lumped into this is because there is one specific acupressure point higher up on the outside of the lower leg (about 3 finger widths up from the ankle bone) that has, in some studies, had a small effect of making contractions stronger once labor has already started, but no actual proof that pressing on that point can trigger or start labor. Basically, acupressure and reflexology can't be done by accident; they are very focused and purposeful types of massage that you can't "trigger" unknowingly, so no gentle, normal types of massage done for foot relief should create any problems.


Myth origin #2: Another direction that I've heard this myth come from was not actually from the massage world. Originally, there was concern about cheap or low-end manicure and pedicure salons who didn't clean their tools correctly, which left the opportunity for women to get infections in their cuticles from the poorly sanitized instruments. Infections during pregnancy are always a concern, so women were encouraged to stay away from cheap nail salons - which, like the old game of telephone, turned into "stay away from all nail salons" -> "Don't get manicures or pedicures while pregnant" -> and finally, (since some salons include a foot or leg massage with their pedicures) -> "Don't get massages on your feet or legs while pregnant". So you can see how something with a small, good intention, can spiral into something much more vague and universal.

Side fact: In all the talk about massaging feet, many times the phrase "and legs" gets lumped in there as well. This one gets a little trickier, because there are some small legitimate concerns about massaging legs during pregnancy. The fact is that due to the increase in a woman's blood volume during pregnancy, and thanks to gravity, a woman's legs can get much more tired, swollen, and heavy while pregnant. Massage can help immensely with these issues, however with this increased blood volume, there is a slim chance that a woman can develop issues such as blood clots in her legs or certain kinds of swelling or edema that a doctor needs to monitor. This does not mean that leg massage is completely off limits, it is just better if any lower extremity massage is done very lightly, or done by a professional who is trained to know what to do and what to look for so that the massage can be done safely. Nevertheless, just because the possibility of concern may be there, if the doctor says everything is fine, the instances of an actual problem can be very slim, so once again, even though there is a small grain of truth in there, it doesn't mean that massage as a whole needs to be avoided when, in the right hands, it can actually be very helpful.

Overall, every pregnant mother does need to be careful about what she does to her body. Despite the plethora of information at our fingertips, with that also comes a plethora of mis-information. If a woman is concerned about whether something heard or read is fact or a myth, she should always ask her doctor. The doctor will give straight information, and even be able to specifically check for any conditions that may make a massage unadvisable. A massage therapist who is specialized prenatal massage should be able to clear up the difference between myths and facts and explain to you why. There is nothing wrong with hearing a myth and striving to be careful, however the best way to be careful is to know the facts behind the myth so that the myth doesn't steer you away from something that might actually be helpful.

The most memorable thing about having a newborn

Many of my prenatal clients are understandably nervous not only about their upcoming labor and delivery, but also what happens after the baby arrives - as far as what to expect and how a newborn will impact their daily life.  This happened to me with both of my newborns, and has happened to so many other people I know who have newborns, I had to make it pretty, and now I do give this advice to my moms-to-be as a humorous warning that though you will be suffering from many sleep-deprived nights, one glorious night will come where you sleep completely through - and what happens immediately after that. It will come, so be prepared.

Holes Are For Donuts, Not Massage Tables

Every so often, I get a new prenatal massage client who takes their first look at my massage table, then they say, “Oh, I thought you had one of those tables with a hole in it”.

Yes, such a thing exists. There are some massage tables that have a hole or some other indentation cut into them to allow extra room for a belly and/or breasts to extend beyond the flat edge of the table when lying face down. You might look at this and say “Great! Perfect for prenatal massages! Who needs their back worked on more than pregnant women?” And when I first started in massage school, I agreed. - I even started saving up for one of those tables. Then I got some real training.

Every massage therapist should come out of massage school with a basic knowledge of how to do a prenatal massage without hurting the mother or baby. However, there is a difference between a basic education and a specialist with advanced training. One of the first things I learned when pursuing my over 80 hours of advanced prenatal and infant massage certifications was that those table holes are not only not recommended, they can actually cause more harm than good.

How? Well, the human body is not stupid. Since we learned to walk upright, our bodies have learned to adapt to the forces around us, including gravity. The laws of gravity say that a heavy object will pull straight down to the center of the earth. When a pregnant woman’s belly begins to grow, there are muscles under and around the belly, particularly one known as the broad ligament, that knows to grow not only out, but also slightly down, working with gravity to support the growing belly. Now take that belly that is growing out and down, and pivot it 90 degrees as if the woman is laying flat on her stomach. The contents of that belly aren't a solid mass - things move in there, so when the stomach is then put at an angle to be affected by gravity, that heavy belly will be pulled straight down and the ligament that is designed to grow out and down, is now being pulled straight out and up. This can cause a strain on that ligament and ultimately more pain in the belly, hips, and low back.

The second reason this type of table is discouraged is because those holes are a universal size, shape, and location. Pregnant women are not a universal size or shape. The chances that that hole is going to properly fit every pregnant woman are slim to none, so how exactly is squeezing yourself into a hole not made to fit you comfortable (or safe)?

These reasons are why I use a side-lying position with specially designed pillows, bolsters, and wedges that allow a woman to relax in a more natural position with everything properly supported without adding any extra strain to anything. I can still get to the back, shoulders, and every body part that needs work without causing the already tense and strained muscles any more problems.

So why do those tables exist if they cause so many problems? Well, the purpose they were designed for is to allow people with that basic training to work on pregnant clients without having to alter their routines or work with a very limited knowledge of how to do a proper prenatal massage. They are especially found in spas where the therapists are instructed to do massages a certain way within a certain time frame, so the tables allow things to stay “as is” without having to add time to the massages, or provide the need for extra equipment or therapists with special additional skills. They are basically an excuse for therapists who don't have advanced skills to charge more for a "specialty service" without having the skills to back them up. Will those tables cause problems for every pregnant woman? Probably not. However, for something so specialized as a pregnancy massage, do you really want to take a chance? You probably should want to look into a therapist that has the skills and training to do the massage correctly, not what is easiest.

Think of those tables like iPhoto. iPhoto allows you to do some very basic editing of pictures, take away red eye, blemishes, crop, etc. They can take a so-so photo and make it ok and it is a fabulous tool for that. But if you are getting married, and need a professional photographer, what would you think if they only used a cell phone and iPhoto for your wedding pictures? You would probably prefer to hire a photographer that had a real camera, multiple lenses, and used photo editing software that would make the average person’s head spin. Prenatal Massage is the same. You could see a therapist that has a tool to make the job 'easy', or you hire a professional who knows what they are doing in depth and the end results between the two will be very different. There is a difference between “giving a pregnant woman a massage” and “Providing a prenatal massage for a pregnant client”. The difference lies in the skills and training of the therapist as well as the tools used. Leave the holes to donuts.

Side note - I know that there are alternatives to both side-lying positions and table holes such as body-positioning systems and so called “Preggo Pillows” both of these solutions claim to also allow pregnant women to lay face down, but also provide more customized and more moveable support to prevent the strain and other issues I’ve spoken about above. There isn’t as much research on them, however this is where I use personal common sense. When a pregnant woman is laying face down, even with support, she is laying ON her baby - with her whole body weight. Even with support, add in the pressure of the massage on her back, and it can’t seem good for the baby - or comfortable for the mom. However, I know therapists and women who have sworn that these systems are fabulous so I can’t condemn them the way I do table holes, but looking at simple physics and having been pregnant myself and knowing how it feels to 'roll over' on the baby, I personally would never recommend those systems.

Prenatal massage can help the pain that comes with being pregnant - a lot. But just like everything else in the world, products are created to monetize and capitalize on solving problems without actually needing the skills to solve the problem. The health care world is no different. So before you schedule your next appointment in massage - or anything else relating to your health for that mater, don't get blinded by what fancy or trendy tools will be used, but do your homework then decide for yourself if something that looks trendy is the best thing for your health and comfort.

Don't believe me? Here is more info to back me up:
http://americanpregnancy.org/pregnancy-health/prenatal-massage/
https://www.massagemag.com/pregnancy-massage-tables-think-before-you-buy-13458/
http://www.turningtidesmidwifery.com/blog/pregnancy-massage-tables-versus-positioning

Will a Prenatal Massage Send Me Into Labor?

Massage therapy has many incredible benefits, especially during pregnancy. However I have had pregnant women tell me is that they are in pain, their backs and muscles ache, but they won't get a massage because they don't want to go into labor. There are a lot of myths and old wives tales about how massage can affect the body. Some are based in fact, some are nothing more than urban legends.

So where does this come from? Several places, actually. One of the most common thoughts is based on the concept of accupressure - a generalized term for types of massage that utilize pressure on certain points in the body and that pressure makes things happen in other parts of the body. The fear comes from the thought if any of these points are touched on a pregnant woman during a massage, the body will immediately try to "eject" the baby. This simply is not true. First of all, the points used in acupressure are not that sensitive. In order to do any type of pressure or point work, pressure must be put on the point and held for 3-5 seconds. A simple massage will not make that happen.

This does not mean that acupressure has absolutely no effect on the body. There are a few points that, when pressed at the proper times, may be able to help labor progress and help strengthen contractions, but it can't initiate anything. (I am speaking on this not just from research, but from personal experience: my oldest daughter was 2 weeks late and I was looking at an induction so I spent the whole weekend before that rubbing and putting so much pressure on every point that was supposed to "send me into labor" that I had black and blue marks. Did it work? Not in the slightest.)

Now you may know someone who has had the experience of "she got a massage and that night she went into labor." Well, that may be partly true, but mostly a coincidence. The answer behind this phenomenon is a little less tangible. What happens in this case is that the massage is most likely not what "started" the labor. Instead what the massage did was relax the body and take away some of the physical and mental stresses that the body was under. The human body doesn't like to do anything, especially anything new or big, when it is under a lot of stress, so when the body relaxes and the stress goes away, it allows the hormones and nerves to act like a signal to the body that says  "Ok, everything is good - go ahead with starting that big thing you need to do." So it wasn't the massage that started the labor, the massage relaxed the body enough that labor was able to start.

Having said all of that, I have in my studies met people who claimed that were certified in something called “Induction Massage”. I have tried to look up information on this, but personally I have yet to find anything about this as a technique or a modality taught in a school. I also asked an advanced prenatal massage instructor about it and she had not heard of it either. So I’m not saying that it is completely impossible for there to be a type of massage that can send someone into labor, but as a disclaimer, I have not been able to find any specific information about this particular certification.

There is never anything wrong with a pregnant mother wanting to be super careful about what happens to her body, and going into labor early is way up there in the top “pregnancy fears” for every mom. But the benefits of a nice, relaxing prenatal massage can far outweigh the fear that it will trigger labor. The best way for a mom-to-be to protect herself is to make sure that any prenatal issues or conditions that may have discussed with her doctor are disclosed to the therapist before the massage, and to make sure she is seeing a therapist who is a Certified Prenatal Massage Therapist, not just one who “can do prenatal massage”.  When in doubt - ask the doctor both if massage is safe for this particular pregnancy, and if he/she can give a referral to a properly trained therapist.