Observations of the Emotional Stages of Pregnancy

When working with pregnant women, it is important to remember they are not only going through immense physical changes, but emotional and spiritual ones too.
Primarily my focus when working with pregnant women is to relieve muscular aches and pains, so that they can regain the joy of their pregnancy. Pain is known to steal the joy out of anyone’s life, but it can be even more acute and devastating for a pregnant woman. Where women are surrounded with images and stories of how precious and joyful the nine or so months of pregnancy can be, it can impose guilt and feelings of loss when a woman finds that she indeed does not like her pregnant state and longs for it to be over.
When receiving a call or meeting a pregnant woman in clinic for the first time I usually hear similar stories and details of their experience dependent on how far along they are in their pregnancy.
When receiving an initial phone call I often get the impression of seeing them searching the internet frantically for a prenatal massage therapist, someone who actually specialises in this technique. i hear the relief in their voice when they realise I understand and know exactly how to help them. Its not that I am some sort of guru in pregnancy complaints, it’s that with experience you can begin to see a pattern emerging.

Prior to 20 weeks:
When I receive a call in the first half of a pregnancy I know the woman is more than likely experiencing moderate to severe lumbar pain and usually there is a history of this condition, more commonly caused by injury. Pregnant women are anxious at this point and feelings of fear creep in, should they “only get worse” as their pregnancy progresses. Never have I had a case where I felt that they were in for a very bumpy ride, with issues that I cannot assist.
In this case it is usually a great sense of fear and trepidation that the pain will keep getting worse the bigger their belly becomes. Fear has a way of highlighting pain and making it seem much worse.
In these circumstances I try to reassure the woman firstly that their aches and pains do not necessarily increase as their bump grows. More often than not they need some gentle remedial stretching and massage through the gluteal (buttock) area in order to release the major muscles that pull on the lumbar area.
I also advise on strengthening and stretching the lumbar, hips and thigh areas in order to create freedom of movement and encourage blood flow and energy flow – basically  to avoid stagnation of blood circulation and flow of the nervous system.

Equipping the woman with something she can do to assist her body gives her power – something which she feels may be taken away as her nausea creeps in, the belly grows, and her body may feel more aches and pains.
Approximately 24wks:

When I receive desperate phone calls from women at this stage of their pregnancy, it usually to report pain in the Symphysis Pubis and Sacro-Iliac joint areas. The pelvis is becoming more unstable as the pregnancy hormones prepare the ligaments for ease of movement in labour. Unfortunately with the ligaments becoming more loose, in some women it means pain can become almost unbearable.
I always take these signs and symptoms very seriously.
Again the woman is usually full of fear and dread about how much more intense the pain may become as the pregnancy progresses. Strengthening and stretching is still part of my treatment protocol, as well as education about standing, sitting, rolling over in bed, sexual positioning and seeing a specialist physio to have a “belly belt” fitted.
Be assured that regular massage has been proven to reduce pain and discomfort in the back and legs (Field, T 1999) and therefore even though the pain will not totally disappear, it can be minimised.
The majority of my clients call when they are approximately 28weeks. I imagine them sitting at their computer at work feeling tight, big and cumbersome, rubbing their lower back and thinking to themselves “…I need to find a massage therapist who can take this pain away…”. Almost always they say that they have pain in their lower back or that they have sciatic pain, but when I ask “…is the pain in your buttocks?” I hear a sigh of relief that they have reached someone who actually understands the real location of their pain. Unless they have a history of injury to their lumbar spine, or have had sciatica before, it is usually a condition known as Pelvic Instability Pain that is causing them grief.
Again, in this instance it is important to ease her fears and talk about how to gently engage the abdominal muscles; do pelvic floor exercises daily and be aware of limiting standing or sitting for prolonged periods of time.

Many women say to me “I told my partner to massage me, but he’s hopeless!”  OR “…that is exactly the the right spot where the pain is…”
Usually I have seen a client one to two times by the time they come for a massage at 33-35 weeks. This is a period that is intensely emotional for the pregnant woman and almost all my clients at this stage will cry at the beginning of a massage when I ask them how they are feeling! This leads me to believe that there is a hormonal surge, which brings with it feelings of exhaustion, frustration and hesitation towards staying pregnant another 7-9 weeks. My clients will often say that they want the baby out anyday now, and that they are “over it”.
If I meet a pregnant woman in the street and we get to talking I can almost guarantee she is 33-35wks just by the way she talks. It is a very emotional period, which thankfully seems to be transient.
Massage treatments during this period are always more gentle and focused on sedating the nervous system rather than assisting the body to heal aches and pains by remedial techniques. I will often spend time on the feet and the scalp to promote deep relaxation and give the client time to experience their body in totality rather than focusing on the areas that are painful most of the time.
From here until the due date I find that my clients gain a renewed vitality and inner peace and begin to look forward to their birthing experience. Unless my clients go over their due date, 36-40wks is a time where they nest, have time off from work, usually get some time to have a pedicure and a wax and have “one last massage or two” before baby comes. These last weeks are wonderful for both the therapist and client as there is a different energy within the massage and we often speak of hopes and dreams for labour and beyond. It can be very rewarding emotionally for me during this period, as I catch the vibe of the pregnant mother.
Post Due-Date:
After 40wks my clients are tired, depressed with thoughts of induction or possible c-section and feeling like their baby will never arrive. With this in mind I offer to perform an induction massage that utilises pressure points which are known for their stimulating effect on the uterus. I believe it is always important to reassure the woman that baby will come in their own timing and nothing I do will force nature’s hand. I can only give things a nudge. I employ the same techniques as for 33-35wks, gentle nurturing work, with the added pressure points and use lots of deep soothing strokes.
These are my observations from working with pregnant women for almost sixteen years.
I do think there is a pattern that becomes unique to each therapist as she brings her particular style and energy to each treatment.
It is my hope that instead of feeling overwhelmed; my pregnant clients will feel supported and have a renewed sense of energy and control over their pregnancy. The stages I have outlined above are transient, so too will be the pregnant woman’s mood and joy.
As in all things, life moves and changes constantly; pregnancy is just another stage of life, and one that can be enjoyed and welcomed given the right advice, guidance and support. Being a massage therapist who specialises in this field, allows me to support each woman in the way they need at that particular time.
Find the right therapist for you:
When looking for a massage therapist during your pregnancy,be sure to ask her how she approaches each client; what her experience is; why she is practicing this speciality and most of all how she would treat your particular concerns. Interview your prospective therapist well, as we are all different and all bring a unique approach to our profession. Massage therapy is like a dance between client and therapist – getting the right “fit” is just as important as having the “gift of touch”.
I have detailed above the common stages and experiences that my clients present with, in the hope that you will know you are not alone and not the first woman to feel the way you do.
Perhaps you are feeling something different?
Feel free to comment on this blog and share your story with us.

Field, T., Hernandez-Reif, M., Hart, S., Theakston, H.,Schanberg, S., Kuhn, C. & Burman, I.(1999). Pregnant women benefit from massage therapy. Journal of PsychosomaticObstetrics & Gynecology, 20, 31-38. 

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