Acupressure & Prenatal Massage

In general most massage is entirely safe during pregnancy, but there are some general considerations to keep in mind. There is a huge difference between the full training in Chinese Medicine of which tuina (medical massage) is a part and our US based massage training. The biggest difference is knowing more about how the body functions in Chinese Medicine terms which then helps you to think through problems better than knowing muscle/anatomy and then possibly a few common acupressure points here and there.

Part of this becomes crucial when you need to decide which patients might be more likely than others to have an issue (i.e. which have the basic underlying Chinese Medicine diagnostic pattern that puts them in the category to be more prone to miscarriage). And it&#39s underlying this issue is why there are no general rules (that and our current legal environment).

Because massage therapists do not have this theoretical training, massage is probably best avoided until about week 15. After that time except in less common circumstances, the baby is well established and not much can go wrong besides obviously wrong techniques - very vigorous work on the low back, deep visceral abdominal massage - things that would be wrong just from a common sense standpoint, not just a training standpoint.

Now there are a range of contraindicated pregnancy acupuncture points which should be looked through, but the general idea is you avoid strong circulation and directional energy in a downward and/or outward direction (which some points do regardless of technique in general terms). And you do this even more so in any patient that shows signs of qi, blood and/or yang deficiency (which would generally be strong signs of fatigue, coldness, etc.).

Now there is acupuncture for labor induction (among many other treatments) so there is a strong clinical basis for the points to move a women to labor - it&#39s used quite often. That said, it generally won&#39t do much unless the woman is already heading that way. That is it works more with the body than forcing it to do something it wasn&#39t going to.

Now all that said, massage can be quite useful for a range of conditions during pregnancy, but some common sense and a basic idea of what to avoid are crucial. To say you couldn&#39t cause an issue with a woman particularly in early term or during an unstable pregnancy would be unethical. But the odds of this with some common sense and a general avoiding of downward and outward points and movements are much lower and the benefits it would offer make it a very viable modality to use during pregnancy.

Mostly, I agree with the above comments. In truth, we don&#39t know what causes miscarriage - if we did, we would be stopping them by now!

However, as a midwife and LicAc, I have to say that, all things being equal, if you don&#39t work from a place of confidence then, don&#39t do it at all. Either inform yourself in more depth of all aspects of interventions in pregnancy, or refer people on to someone who does have the confidence and experience. There was a study published in The Lancet, c2001, where physiotherapists did acupuncture to alleviate low back pain in mid-to-third trimester pregnant women. About 28% delivered before 36 weeks, way above the expected UK average of 8% (at the time). They did the &#39right&#39 back pain treatment but, didn&#39t know many were contra-indicated points. The study has now been removed from archives.

It&#39s a tough call, for sure. How else will you gain the experience and knowledge if you don&#39t have the opportunity to learn and practice clinical skills? If there is someone you can intern with, spend some time with, who treats lots of pregnant women, then maybe you should ask them to instruct you. If you are thinking of teaching it is vital you are clear about what needs to be said and shown - students are not armed with the knowledge and experience to discern for themselves what to do in various situations. And it can only enhance your own practice and reputation!