As a long-time massage therapist, childbirth educator, and labor support doula, I often get asked a question by those who know I’ve worked through three pregnancies. It usually comes in the form of a panicked e-mail or private message: “Help! I just found out I’m pregnant! Can I still do massage therapy or work at the spa?” The short answer is, yes, of course you can perform bodywork as a pregnant woman. In fact, most doctors will recommend that pregnant women continue their normal level of activities as long as they feel comfortable doing so.¹ But the long answer is a bit more complicated.
Bodywork During the First Trimester
For many pregnant women, the first trimester is the most difficult. The level of fatigue or nausea can surprise you during those early weeks of pregnancy. Even before you realize you are pregnant, you might feel flu-like symptoms and think about canceling or rescheduling a client due to the stomach bug you think you caught. Once you’ve confirmed your pregnancy, however, there is no need to cancel clients due to nausea unless you feel you will actually be sick.
The biggest key with morning sickness is to eat small, frequent meals, so a pregnant bodyworker should schedule enough time between clients to snack on a few wheat crackers, a slice of cheese, and a handful of grapes. Eating every hour or so keeps blood sugar levels regulated. Drink some soothing peppermint tea, energizing juice, or water between clients and make sure you allow enough time to grab a quick bite. This might mean you need to decline providing longer spa treatment sessions or two-hour massages.
The other thing that helps keep morning sickness at bay is to suck on hard candy. Peppermint candies are traditionally considered very helpful, but others have reported that hard caramels, Life Savers, or Jolly Ranchers can ease nausea while you are trapped in the massage room. Keep a dish of half-unwrapped candies near the table so you can easily grab one and pop it in your mouth without touching the candy itself.
Fatigue can also plague many pregnant women during their first trimester. Try keeping a clear spot in your schedule to allow a catnap during the afternoon, even if you aren’t able to leave the spa, office, or clinic. Eliminating caffeinated beverages and being sure to get a full night’s sleep will also help prevent energy lags in the afternoon.
Be sure you touch base with your clients at each visit to find out about their health status. Some illnesses that would be inconvenient or minor to you can be serious to an unborn fetus.² Don’t be afraid to ask your clients each week if they or anyone around them has had any sort of infectious illnesses recently.
First Trimester Concerns
When Should I Tell My Clients?
This tricky question doesn’t have one answer that will be right for everyone and every situation. If morning sickness or fatigue creates serious problems for you, and you have to move a client around or cancel at the last minute, it might be good to let them know what’s going on. My clients have always been very understanding, although my morning sickness only caused minor inconveniences for me.
You have to continue working with your clients in a professional way, no matter what happens in your personal life. Make adjustments to your availability as needed, but try not to cancel on clients you’ve already booked.
Women who are high-risk for miscarriage, however, may not want to reveal their pregnancy until they are further along. Or you may not feel comfortable letting your clients know about your personal life. Consider, however, that you will probably not be able to hide your pregnancy past the second trimester and will need to think about how to make the announcement before rumors start flying.
What Spa Treatments Should I Avoid?
Anything that raises your body’s core temperature should be avoided. If you are doing a hot wrap, hot stone massage, or taking care of a client in a sauna or bath type situation, be sure you are not getting overheated. Hot stone massage, for example, won’t heat your entire core temperature as long as the room itself isn’t getting too hot.
Any essential oils that are contraindicated for your pregnant clients are also contraindicated for you as a pregnant therapist. Some massage therapists prefer to give up all treatments and massages using essential oils through the entire pregnancy.³ Other pregnant women choose to avoid all essential oils during the first trimester and add back the gentler oils in later months of pregnancy. Generally, the essential oils listed above right are considered safe for use during pregnancy when properly diluted.4 Discuss any concerns you may have with an aromatherapist or your care provider.
Bodywork During the Second Trimester
Most pregnant women find they have incredible energy levels during the second trimester, making it easy for them to resume a full work schedule. If you avoided telling people you are pregnant during your first trimester, you will not be able to hide it much longer.
It is easier to tell clients about your pregnancy if you already have some kind of postpartum plan in place. Even if it is as simple as, “I wanted to let you know that I’m expecting a baby this coming spring and will probably be on maternity leave in April.” This gives your clients a heads-up, so they do not get caught off guard by your disappearance. After all, those clients who come every quarter or every other month can plan their appointments around your maternity leave if they know when it will be.
The increasing blood volume in your body the second trimester can make you feel more congested and even a bit light-headed. Avoid standing too quickly from a sitting position to help avoid these dizzy spells. Do not bend over from the waist; rather, bend your knees and squat to pick something up from the ground or under the table to help avoid sinus pressure and back strain.
The last second trimester challenge is a phenomenon known as pregnancy brain. This is very real and is simply a forgetfulness and lack of concentration that can make it hard for you to remember appointments, clients’ names, or other simple tasks. Use an appointment book, day planner, and receipt pads to keep track of everything, even if you’ve never needed to in the past.
Second Trimester Considerations
Let’s talk for a moment about professional boundaries. It is easy for these lines to blur when you’re pregnant. Clients will come in and ask questions about how you’re feeling, who your care provider is, what color you are decorating the nursery, and a host of other baby-related questions. It is easy to get caught up in the excitement of motherhood-to-be and forget that our primary responsibility as a massage therapist is to take care of our client, not have our emotional needs fulfilled by talking about ourselves. Usually a brief answer assuring the client you are well, and then asking what their goals are for the bodywork session, will bring the focus back to your client.
Bodywork During the Third Trimester
If you haven’t made arrangements for your clients and business after your baby arrives, this is definitely the time to do so. If you work as an employee, find out what, if any, family leave benefits you have. If you work as an independent contractor, set aside extra money each week so you will have something to draw from during your maternity leave. Plan for an extra cushion beyond what you anticipate. If you think you will only take off a week before the baby is due, plan for extra time in case of medical emergency, bed rest, or an overdue baby. Also think about your options if the baby comes early.
As your belly grows, body mechanics can fall by the wayside if you aren’t careful. Concentrate on maintaining good body mechanics throughout your massage sessions. Do not let your back sway too much; maintain an upright core posture. Keep your feet facing the same direction, so your hips are square and level. As the pregnancy hormone relaxin increases in your body, your joints will become more loose and mobile, requiring you to keep a strong, steady base.5
Wear comfortable, supportive footwear, since the weight gain can increase the strain on your feet, causing them to widen. Kick off those cute sandals or useless flip-flops and get a pair of tennis shoes. You may need a size wider than what you used to wear.
You may need to lower your table a notch or two in order to work around your growing belly. Don’t feel like you have to reach from the top of the head all the way down the back in one long stroke. Take a step to the side of the headrest and step closer to the table. Work one side at a time if necessary.
I am a short person, not quite 5’4” and one trick I found immensely helpful was to keep a small aerobics step underneath the table. When I needed a little extra height, I could reach under the table and pull the step out with my foot, never taking my hands off the client. An extra couple inches allowed me to reach easier, without having to lower the entire table. This trick worked perfectly for reaching glutes or shoulders on a thicker client who would have otherwise caused me to strain myself. When I moved on to another part of the body, I just stepped down and slid the step back under the table with my foot. If you are fortunate enough to have a hydraulic table, you can make these adjustments as you go.
Another consideration during the third trimester is the increase in fluid buildup in the body. This is a natural defense your body has in place against blood loss during childbirth, but can make you more prone to carpel tunnel-like symptoms. Try using the back of your knuckles or loose fist during effleurage massage strokes, instead of using the heel of your hand, which can cause a “break” in your wrist. Keeping your wrist joint all in line will help decrease any extra stress on the joint.6
If you usually do a very active massage technique, or something like Ashiatsu barefoot massage, you may need to make other arrangements during the last few weeks of your pregnancy. Most therapists find that through the vast majority of their pregnancy, they are able to continue working at a similar, or only slightly slower, pace than pre-pregnancy.
Also, during the last couple weeks, be sure you let your clients know that you reserve the right to cancel a session if necessary. Each night, I wrote out a list of the names and phone numbers of the clients who were scheduled the following day in case I woke up that night in labor. I didn’t want to have to worry about trying to find their information to call and cancel while having contractions. For the last few days before I delivered, I’d say goodbye to clients by saying, “See you Saturday … maybe,” and we’d both laugh.
Third Trimester Considerations
This may seem silly, unless you are seven months pregnant, but the most common question I hear about the third trimester is, “What if my belly hits the client during the massage?” Your belly probably will hit your clients at some point during your pregnancy and there really isn’t any way around it. Your clients probably won’t notice or worry any more than they do if your arm brushes against them during a regular session. However, if you feel self-conscious about it or the client giggles, just apologize. “Whoops, sorry about that,” is enough for most clients. If it’s near the beginning of the massage, and the client is still more alert, you can even make a simple joke: “I guess the baby wants to help.”
Standing to the side of the table and using the small aerobics step, when needed, will decrease the likelihood of a belly-bump happening. Turning so that you are facing toward the head or the foot of the table, instead of facing directly toward the table, will also help. Ultimately though, it really isn’t a big deal, and if you’ve put your client to sleep with your relaxing bodywork, he or she may not even notice.
If you are worried about too much swelling in your feet and legs during the last couple weeks, consider changing your massage sessions and doing more from a seated position. Lower your table and work the head, neck, and shoulders from a stool or exercise ball chair. Or run a special on facial massages, or foot massage treatments, so you can do more of the work sitting down.
When Should I Start My Leave?
There are several right answers. I handled each pregnancy differently according to what was needed at the time. With one baby, I worked as a full-time massage therapist with a chiropractor and had several clients in the middle of treatment plans. I worked full-time until the day before my labor started, and I started back with short, 30-minute sessions only two weeks postpartum.
With my most recent pregnancy, I had some back pain during the last month, which made doing massage therapy more difficult, so I left for my maternity leave a week before the baby arrived and took a full month off for maternity leave. I made arrangements with another massage therapist to take over my regular clients while I was on leave. I also made a point of keeping my phone close at hand, so I was still able to talk with my clients and refer them out as needed.
How Do I Start Back After My Baby is Born?
Working after the birth of a baby can be a complicated and overwhelming prospect. The key is pre-planning and communication. Many massage therapists find themselves working by appointment only or cutting back their days of availability after the birth of a child, although it is certainly possible to continue working full time.
Send out a mailing to your clients with a birth announcement and include the dates of when you plan to start back. I usually call all my regular clients to let them know when I’m available, since sometimes they don’t want to “be an inconvenience” too soon. A check-in phone call will let them know you are back in business and help you get back into a routine.
Each pregnancy is unique, so listen to your body and do what you are able. Remember that your clients deserve your full attention and effort. Shift your schedule as needed to make time for self-care and stay in close communication with your clients. Enjoy these busy months of drastic change, because they will not last long. Learning to juggle your pregnancy and your business will be just the first of many decisions you’ll face as a new parent.
Angela England has been a massage therapist for more than seven years, in addition to being a mother of three, freelance writer, childbirth educator, and doula. Visit her website at http://angengland.com.
Notes
1. American College of Obstetricians and Gynecologists, Exercise During Pregnancy Guidelines, AP119 (2003) Available at www.acog.org/publications/patient_education/bp119.cfm (accessed June 2009).
2. Martha Sears, Williams Sears, and Linda Hughley Holt, The Pregnancy Book (New York: Little, Brown and Company, 1997).
3. National Association for Holistic Aromatherapy, Frequently Asked Questions Page. Available at www.naha.org/faq_pregnancy.htm (accessed June 2009).
4. Kathi Keville and Mindy Green, Aromatherapy: A Complete Guide to the Healing Arts (Berkeley, California: Crossing Press, 2009).
5. “Good Posture During Pregnancy,” WebMD. Available at www.webmd.com/baby/guide/posture (accessed June 2009).
6. Art Riggs, “The Tools: Part One of Deep Tissue Massage,” Massage & Bodywork (February/March 2005). Available at www.deeptissuemassagemanual.com/MassBodywork_Pt1.pdf (accessed June 2009).
Getting Back to Business After a Baby
1. Check With Your Doctor or Midwife First
Of course, you will want to make sure you are cleared for returning to a physical job like massage therapy. Since most massage therapists work from a standing position, you will want to be sure your healthcare provider knows what your job entails.
2. Ease Back Into Work
Massage therapists usually work for an hour at a time, but it can be difficult to begin with full-length sessions at the very start. Some therapists will begin working with only 30-minute sessions or offer specials on work that can be performed with the therapist sitting down.
3. Communicate With Clients
You have several months to prepare a maternity leave plan and a postpartum plan. Be sure your clients know how long you are anticipating taking off for maternity leave.
4. Send Baby Announcements With a Date of Return
Send out postcards announcing the baby’s arrival and a date for your return. Don’t print the date until you can really judge your physical ability to return, but you can preprint the address labels to minimize your stress postpartum.
5. Offer a Welcome Back Special
Some massage therapists offer a special to encourage clients to return. One therapist in Florida had the baby say it all: “My mom is so glad I’m here, she wants to share her excitement. Please take $10 off your next massage appointment.”
6. Consider the Baby in Your Schedule
You will want to allow enough time between clients to breast-feed or pump to keep your milk supply up. Visit the Le Leche League website for more information about breast-feeding and working (www.llli.org).