Pregnancy Massage Positions
By Lubna Sheikh on 5th July 2020
The general health benefits of massages are endless. For centuries, specialists have used massage therapies to promote relaxation, reduce stress, and help individuals recover from various ailments. When it comes to pregnancy, it goes unsaid that the toil of carrying a human inside you for almost a year puts the female body through the works. Both joyous and unpleasant experiences arise during pregnancy, but both mean that each woman has a duty to looking after herself and her baby now more than ever.
Table of Contents
- 1. Pregnancy massage benefits
- 2. Why position matters
- 3. The Side-lying position
- 4. How to Side-lie properly
- 5. When side-lying should be used
- 6. Prone position massage
- 7. Supine position massage
- 8. Semi-reclining position
- 9. Pregnancy massage tables
- 10. Importance of bolstering
- 11. Conclusion
- 12. References
Why Get A Pregnancy Massage?
Pregnancy massage has been known to reduce stress and anxiety, alleviate aches and pains from muscles under increasing strain, reduce symptoms of depression, and can even prepare the body for labour. 
Swedish massage in particular also improves blood circulation and the lymphatic process. This is why it is the preferred massage technique during pregnancy. It is renowned for addressing hormone shifts and skeletal changes that a woman undergoes during gestation. The wonders of pregnancy massage don’t stop there: it can also reduce swelling (edema), regulate the hormones and can contribute to improved sleep.
This is because it’s all about relaxation, and giving the body the love and attention it deserves. But most importantly is your comfort and safety, which is why there have been many contraindications about positioning during pregnancy massage.
Why Position Matters During Pregnancy Massage
Despite the obvious and glorious baby bump, pregnancy is the time the female body changes the most during her lifetime. But most of these changes occur inside, and cannot be seen by the naked eye. So, whenever a massage therapist receives a request for pregnancy massage, their first thought is their client’s comfort. While it is all about relaxation and calm, the most important thing is the safety of the mother and foetus.
One of the main challenges of pregnancy massage is subjectivity. Each woman is different, and becomes accustomed to their own favourite positions. What works for one expectant mother, for example lying flat on her back with her face towards the ceiling, would be extremely unnerving for others. Meanwhile, modern creation has provided massage therapists with amenities such as ‘bolstering’ pillows, reclining chairs, and even tables with holes in the middle to accommodate the growing bump. But some mothers still find this position unnerving.
We will later discuss the various positions and their pros and cons, but one thing experts’ acclaim throughout is the alignment of the body. Good cervical alignment of the head is essential, which can be achieved through the use of pillows and cushions.
Why is Sidelying the Best Position to Lie in During Pregnancy Massage?
The ‘lateral recumbent’ position, also known as the sidelying position, is the safest and most effective position for any female. Using pillows and cushions to bolster the expectant mother means she can relax into it safely, and find her own comfort in the moulds. Sidelying is the safest position for the following reasons:
- Reduces strain in the uterine ligaments (the part which connects the walls of the uterus to the pelvis)
- Does not put strain on the musculoskeletal structure
- Relieves strain on intrauterine functions
- Prevents sinus pressure
- Promotes somato-emotional integration
Generally, healthcare professionals encourage sidelying as it helps foetal and placental circulation, especially during high-risk pregnancies. This is why massage therapists ask mothers to lie to their side. Lying on the left side is generally preferred, as it encourages foetal oxygenation and maternal cardiac functioning. 
How to Position Properly on The Side
Massage therapists will be inclined to follow guidelines when it comes to positioning on the side. The use of several sizes of soft pillows and harder pillows is recommended along the body, and one under the head. This is so the torso is aligned with the cervical spine, and not stretched too far or curved. Use more pillows to prop the space between the acromioclavicular joint (the joint at the top of the shoulder) and her head in order to prevent excessive pressure to her shoulder.
Supporting the pubic bone is also key, so you should tuck a small soft pillow underneath the abdomen. This pillow should be around eight inches thick, and should be placed near her pubic bone to provide uterus support and stop any lumbar strain or uterine ligament damage. To allow proper venous flow, extend the bottom leg so it is in a posterior position on the table to the other leg.
For the leg that’s facing upwards, place a pillow that’s thick enough underneath the knee to create a horizontal line between the ankle, knee and hip. This position helps reduce the risk of leg edema, alleviates pain from varicose veins, and prevents sacroiliac joint pain. 
When the Sidelying Position Should Be Used
There has been a lot of contraindications about pregnancy massage within the first trimester. Some claim this can cause miscarriage, can damage the embryo, or can give way to further medical complications. The decision to undergo a pregnancy massage during this time is completely down to you and your pre-natal advisor.
However, in terms of safety and the sidelying position (which is the safest resting position for any expectant mother), your therapists are normally comfortable performing a pregnancy massage on mothers who are 22 weeks gestated or more. This is because the baby is around 1.5 to 2 pounds, and the top of the uterus is visible and above the navel. Generally sidelying is advised for any expectant mothers who have any of the following conditions:
- Problems breathing in other positions
- Hypotension when lying face down
- Suffer from back pain when facing down or facing upwards
- Severe nasal congestion that becomes worse when lying face down
- Women who are obese
- Breast tenderness when lying face down
- Mothers who put communication above positioning
Can I Lie on My Tummy During Pregnancy Massage?
Pregnancy is a process which heightens your awareness and knowledge of your own body, right? Most mothers do not like lying in what we call ‘prone position’ (lying face down.) Although medical professionals say this is safe to sleep in, once pressure by a massage therapist is applied, it no longer stays a safe position. This is why we advise against prone positioning massages.
Lying on your tummy can put strain on the uterine, pelvic and lumbar structures. It also shortens what we call the posterior musculature – a section of muscles that goes from your pelvic bone to femur which are crucial in stabilizing the pelvis. When pregnant, lying face down also compresses the lower back which can lead to displacement, and puts more strain on the ligaments which hold up the cervix (Sacro uterine ligaments.)
Therapists, pending on your wishes, have been trained in treating clients in this position during the first trimester only. We proceed with caution if there is concern about foetal blood supply, or if there are placental abnormalities or uterine incompetence. This position can also be extremely discomforting for enlarged breasts, resulting in a spike in mucous production. 
If you are considering lying in the ‘prone position’, make sure to run this through with your doctor or therapist. Other elements to consider are whether communicating with your therapist, or partner if present, is important to you as this is often impossible when lying face down during a pregnancy massage.
Can I Lie Flat on My Back During Pregnancy Massage?
Having explored the dangers of lying in the prone position, one would assume that a safe position would be lying in the exact opposite: lying on your back with your face towards the ceiling. But this position, which we call ‘supine’ also comes with certain dangers during pregnancy.
The uterus in this position presses against the large vein that carries blood into the heart (the vena cava.) This strain will result in reduced circulation for both the foetus and the mother. Even if this position seems comfortable, which it does for many pregnant women, the effects are internal.
Most healthcare providers advise against lying on your back altogether throughout pregnancy – however, this can be a comfortable position. If you feel you would like to experience a massage in this position and you are in the first trimester, try using pillows for support under the right side of your stomach. This will shift the weight of the uterus towards to the left, and increase oxygenation. 
What Does the Semi-Reclining Positioning Entail?
Because of the dangers of supine positioning we outlined above, semi-reclined positioning is a great compromise for some situations. This is often preferred by most of our clients who find it difficult to get comfortable in the sidelying position. Semi-reclining can alleviate symptoms of hip soreness, nausea, heartburn, and more.
This position can be used when the expectant mother is not comfortable lying in the side position, or when she has intense heartburn, nasal congestion, or nausea when lying in the sidelying position. Furthermore, a semi-reclining position is wonderful for mothers who are close to their due date, and is happy to receive a massage in the position that she is intending to deliver in. This can get the mother accustomed to the feeling, and promotes a sense of calm, alertness, and control.
What Are the Dangers of Pregnancy Massage Tables?
Pregnancy massage tables are another so-called-wonder of the 21st century. They adhere to the concept of seeing the bump as an ‘obstacle’ and the solution is creating a gap for your lovely, blossoming bump to fit into. But this shouldn’t be the case. Gestation is fundamentally carrying human life, and pregnancy massage should not contradict the importance of this. Instead of the bump fitting to the table, the whole treatment should revolve around the bump. Here’s a list of reasons why pregnancy massage tables are not recommended:
- They provide zero support for the back and stomach: if you’re trying to avoid lower backpain, this is definitely not the option for you. Therapists will more than likely apply pressure to your sore points during a pregnancy massage, but with your stomach hanging free in the gap, this could lead to excessive pressure and pain
- They’re one size fits all: while your stomach grows, the hole in the table remains the same. We have highlighted in this post how every woman and every pregnancy is different, but these massage tables do not consider that. What seems comfortable for one woman might be too tight or too lose for another
- More stretchmarks are likely: we all know the weight of the unsupported belly will stretch the skin more than usual. This could exacerbate current stretch marks or even cause new ones
- It won’t allow you to relax: have you ever had a massage, put your forehead in the face hole and remained on edge throughout the massage as something just wasn’t quite right? This is the case here. Your lovely stomach, soft and blooming, will be pressed into a small unyielding hole and remains unsupported while your body is intended to relax
The Importance of Bolstering During Pregnancy Massage
Here are a few quick tips to remember when placing pillows, or’bolstering’, to prepare for a pregnancy massage:
- Lumbar support is also essential, which can be achieved through placing a pillow under the waist.
- To support the breasts and prevent anterior torso rotation, place a small pillow between the underarm and chest.
- To keep all joints horizontal and promote hip and knee comfort, a pillow can be placed between the knees, under the hip bone, and under the ankle. This means mum will be fully supported and, in an alignment,
- Place a pillow under the upper arm which will prevent a curve or twist of the spine.
Pregnancy is a wonderful time and as an expectant mother, you deserve to rest, relax and connect with your body in a way that only you know how. If you have any concerns or questions, you are highly advised to contact your therapist to discuss these queries. Furthermore, consult your pre-natal doctor or OBGYN – remember, no question is a silly question when it comes to the safety of you and your baby. Also bear in mind that once treatment starts, if you do decide to go for it, it does not require you to sit there uncomfortably because you’re afraid to say anything. Good communication is key to a relaxing and risk-free massage.
About the author of this article
My name is Lubna and I am a Holistic Food Coach, Natural Chef, Massage Specialist & Yoga teacher. I am passionate about your health and well-being. Now, health and well-being is my life! I practice yoga every morning. I attend and support my community fitness centre and I have recently learned how to swim.