Massage Therapy in Pregnancy
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Questions and Answers

What is the primary role of a massage therapist during pregnancy?

  • To treat only musculoskeletal issues
  • To replace obstetric care
  • To monitor for signs of fetal distress
  • To act as an educator and advocate for the pregnant person (correct)

    • What is the approximate total weight gain during pregnancy?

  • 30-40 lbs
  • 10-15 lbs
  • 15-20 lbs
  • 20-30 lbs (correct)

    • What is the name of the hormone responsible for ligamentous laxity during pregnancy?

  • Estrogen
  • Relaxin (correct)
  • Oxytocin
  • Progesterone

    • Which joints are at increased risk of injury and sprain during pregnancy?

    <p>Lumbosacral, sacroiliac, sacrococcygeal, hip, knee, ankle, and foot</p> Signup and view all the answers

    What is the result of anterior carriage of weight during pregnancy?

    <p>The centre of gravity shifts upward and forward</p> Signup and view all the answers

    What is the effect of breast enlargement on the shoulders during pregnancy?

    <p>The shoulders rotate anteriorly</p> Signup and view all the answers

    What is the recommended training for massage therapists who wish to specialize in pre/post-natal massage and infant massage?

    <p>Post-graduate training</p> Signup and view all the answers

    What is the result of the person shifting their weight to their heels during pregnancy?

    <p>Throwing their upper back posteriorly</p> Signup and view all the answers

    What is a result of anterior head carriage?

    <p>Shortening of the posterior cervicals, upper trapezius, scalenes and sternocleidomastoid muscles</p> Signup and view all the answers

    What happens to the heart rate during pregnancy?

    <p>It increases by 10-15 beats per minute</p> Signup and view all the answers

    What is the result of decreased peripheral vascular resistance during pregnancy?

    <p>A decrease in blood pressure</p> Signup and view all the answers

    What is Vena Cava Syndrome caused by?

    <p>Compression of the inferior vena cava by the fetus</p> Signup and view all the answers

    What is the result of the diaphragm becoming compressed and elevated during pregnancy?

    <p>A decrease in the vertical height of the lungs</p> Signup and view all the answers

    Why do many people become mouth breathers during pregnancy?

    <p>Due to a change in proprioceptive information</p> Signup and view all the answers

    What is a result of the kidneys, bladder, and ureters expanding during pregnancy?

    <p>Increased urinary volume</p> Signup and view all the answers

    What is a potential complication of pregnancy affecting the kidneys?

    <p>Pyelonephritis</p> Signup and view all the answers

    What is a symptom of compression of the bladder by the fetus?

    <p>Increased sense of urgency</p> Signup and view all the answers

    What happens to the blood volume during pregnancy?

    <p>It increases by up to 40%</p> Signup and view all the answers

    What is a common symptom experienced by women during the first 14-16 weeks of pregnancy?

    <p>All of the above</p> Signup and view all the answers

    What is the primary function of the hormone Relaxin during pregnancy?

    <p>To hydrate and loosen ligaments in preparation for delivery</p> Signup and view all the answers

    What is the approximate length and weight of the fetus at the end of the first trimester?

    <p>2-3 inches, 2 oz</p> Signup and view all the answers

    What is a common emotional change experienced by women during the first trimester?

    <p>All of the above</p> Signup and view all the answers

    What is the primary cause of constipation during pregnancy?

    <p>Decreased intestinal motility</p> Signup and view all the answers

    What is the term for the separation of the Rectus Abdominus along the linea alba during pregnancy?

    <p>Diastasis Recti</p> Signup and view all the answers

    When do women typically start to feel fetal movement during pregnancy?

    <p>Around week 20</p> Signup and view all the answers

    What is the term for uncontrolled vomiting resulting in dehydration and weight loss during pregnancy?

    <p>Hyperemesis</p> Signup and view all the answers

    What is the approximate duration of a full-term pregnancy?

    <p>38-42 weeks</p> Signup and view all the answers

    What is a common physical change experienced by women during the second trimester?

    <p>Visible change in physical appearance</p> Signup and view all the answers

    What percentage of blood volume increases during pregnancy?

    <p>35-50%</p> Signup and view all the answers

    What is a possible cause of shortness of breath during pregnancy?

    <p>Fetal compression of the diaphragm</p> Signup and view all the answers

    What is a high-risk pregnancy condition that can cause maternal bleeding and obstruction of the birth canal?

    <p>Placenta Previa</p> Signup and view all the answers

    What is the term for the partial or complete premature detachment of the placenta?

    <p>Placenta Abruptio</p> Signup and view all the answers

    What is the term for the separation of the bellies of the rectus abdominus along the linea alba?

    <p>Diastasis Recti</p> Signup and view all the answers

    What is the term for the development of diabetes during pregnancy due to increased glucose levels in the blood?

    <p>Gestational Diabetes</p> Signup and view all the answers

    What is the term for a blood pressure greater than 140/90mm Hg during pregnancy?

    <p>Pregnancy Induced Hypertension</p> Signup and view all the answers

    What percentage of pregnancies are considered high-risk?

    <p>20-25%</p> Signup and view all the answers

    What is a possible emotional change experienced by mothers during pregnancy?

    <p>All of the above</p> Signup and view all the answers

    What is the approximate length and weight of the fetus at 39 weeks?

    <p>16-19 inches, 5-10 pounds</p> Signup and view all the answers

    What is a primary aim of treatment during the 1st trimester of pregnancy?

    <p>Treat SNS firing</p> Signup and view all the answers

    What is a key consideration when performing massage during the 2nd and 3rd trimesters of pregnancy?

    <p>Avoiding deep pressure over the low back</p> Signup and view all the answers

    What is a primary goal of post-partum massage?

    <p>Restore posture and muscle strength</p> Signup and view all the answers

    What is the systolic blood pressure measurement that may indicate pre-eclampsia?

    <p>30mm Hg above baseline</p> Signup and view all the answers

    Which of the following is a symptom of pre-eclampsia?

    <p>Edematous weight gain of over 2lbs/week</p> Signup and view all the answers

    What is a common modification made during pregnancy massage to accommodate the growing abdomen?

    <p>Using a pillow under the upper torso and pelvis</p> Signup and view all the answers

    What is a key consideration when performing massage on the legs during pregnancy?

    <p>Avoiding deep or direct pressure over varicose veins</p> Signup and view all the answers

    Who is at risk of developing pre-eclampsia?

    <p>All of the above</p> Signup and view all the answers

    What is a primary aim of treatment during the 3rd trimester of pregnancy?

    <p>Prepare for delivery and provide emotional support</p> Signup and view all the answers

    What is the treatment for eclampsia?

    <p>Patient restraint, avoidance of seizure triggers, and IV meds</p> Signup and view all the answers

    What is a common symptom addressed during pregnancy massage?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of disseminated intravascular coagulation?

    <p>Uncontrolled activation of clotting factors</p> Signup and view all the answers

    What is a key benefit of massage during pregnancy?

    <p>All of the above</p> Signup and view all the answers

    What is the indication of pre-eclampsia?

    <p>Rapid edema formation and weight gain of 2lbs/week or more</p> Signup and view all the answers

    What is a key consideration for the massage therapist during pregnancy?

    <p>All of the above</p> Signup and view all the answers

    What is the possible cause of vaginal bleeding after the 1st trimester?

    <p>All of the above</p> Signup and view all the answers

    What is the possible cause of sudden high fever during pregnancy?

    <p>Infection</p> Signup and view all the answers

    What is a key aspect of post-partum massage?

    <p>All of the above</p> Signup and view all the answers

    What is the possible cause of lack of fetal movement?

    <p>Stillbirth</p> Signup and view all the answers

    What is the purpose of applying vibrations to the lower abdomen during pregnancy massage?

    <p>To reduce constipation</p> Signup and view all the answers

    What is the condition characterized by excessive amniotic fluid volume?

    <p>Hydramnios</p> Signup and view all the answers

    What is the benefit of applying pure vitamin E to the abdomen during pregnancy?

    <p>To reduce stretch marks</p> Signup and view all the answers

    Why should special care be taken when working with the pectorals and axillae during pregnancy massage?

    <p>Due to increased congestion and lymphatic activity</p> Signup and view all the answers

    What is the purpose of using drainage techniques in the face during pregnancy massage?

    <p>To reduce edema</p> Signup and view all the answers

    Why should pressure be decreased and direct pressure avoided over varicose veins during pregnancy massage?

    <p>Due to risk of further vein damage</p> Signup and view all the answers

    What is the benefit of using heat to the low back and gluteals during hydrotherapy?

    <p>To reduce pain and improve circulation</p> Signup and view all the answers

    Why should the client be positioned on their side with their legs over the edge of the table at the end of the treatment?

    <p>To reduce dizziness and abdominal strain</p> Signup and view all the answers

    What is the purpose of using cool or cold figure '8' wraps around the breasts during hydrotherapy?

    <p>To reduce pain and congestion</p> Signup and view all the answers

    Why should treatment times be shortened if the client is experiencing discomfort?

    <p>To accommodate the client's comfort level</p> Signup and view all the answers

    Why should the client be monitored for blood pressure before each treatment?

    <p>To monitor for any underlying medical conditions</p> Signup and view all the answers

    What should you include when requesting consent for breast massage treatment?

    <p>The rationale for treatment, the area being worked on will be uncovered, and the client has the right to refuse, stop or modify the treatment at any time</p> Signup and view all the answers

    What is a common issue that can result from habitually poor posture and tight-fitting undergarments?

    <p>Breast congestion and chronic pain syndromes</p> Signup and view all the answers

    What is a possible option you can offer to a client who is uncomfortable with direct work on breast tissue?

    <p>Offering suggestions for self-care and hydrotherapy techniques</p> Signup and view all the answers

    What can a knowledgeable and trained therapist do to enhance blood and lymphatic flow in the breast tissue?

    <p>Use a combination of massage techniques and hydrotherapy</p> Signup and view all the answers

    Why may some clients be uncomfortable with breast massage?

    <p>They are shy or uncomfortable with their body</p> Signup and view all the answers

    What can scars and fascial restrictions contribute to?

    <p>Chronic pain and reduced range of motion</p> Signup and view all the answers

    What should you do before uncovering the breast tissue during a massage?

    <p>Check in with the client to see if they are still okay with the work</p> Signup and view all the answers

    What is a possible cause of breast pain?

    <p>All of the above</p> Signup and view all the answers

    What can a therapist do to help a client who is uncomfortable with direct work on breast tissue?

    <p>Offer suggestions for self-care and hydrotherapy techniques</p> Signup and view all the answers

    What is a characteristic of Fibrocystic Breasts?

    <p>Nodular, granular breast masses that become more prominent and painful just prior to and during the first few days of menstruation</p> Signup and view all the answers

    What is a feature of Cysts in the breast?

    <p>Usually bilateral and multiple, predominating in the supero-lateral aspects of the breast</p> Signup and view all the answers

    What is a possible ominous sign?

    <p>Nipple discharge that is crystal clear, grayish-green or bloody</p> Signup and view all the answers

    What is a characteristic of Keloid?

    <p>Excessive scar tissue formation containing blood vessels</p> Signup and view all the answers

    What is an important aspect of the Assessment Case History?

    <p>All of the above</p> Signup and view all the answers

    What is a possible cause of breast congestion?

    <p>Hormonally related breast congestion</p> Signup and view all the answers

    What is a feature of Fibroadenoma?

    <p>Firm, rubbery, sharply defined round mass</p> Signup and view all the answers

    What is a possible observation in breast assessment?

    <p>Presence of scars, radiation markings, visible lumps, tissue texture or colour changes</p> Signup and view all the answers

    What is a possible causative factor of breast pain?

    <p>All of the above</p> Signup and view all the answers

    What is the primary function of the suspensory ligaments in the breast?

    <p>To provide structure and support to the breast</p> Signup and view all the answers

    What is the anatomical boundary of the breast tissue medially?

    <p>Sternal midline</p> Signup and view all the answers

    What is the function of the lobules in the breast tissue?

    <p>To propel milk into ductules</p> Signup and view all the answers

    What is the name of the venous plexus that drains into the Internal Mammary Vein?

    <p>Venous plexus deep to areola</p> Signup and view all the answers

    Why is it important to avoid techniques that might unduly stress or stretch the breast tissue?

    <p>Because it may damage the suspensory ligaments</p> Signup and view all the answers

    What is the result of avoiding adequate training on breast massage?

    <p>Reinforcement of a subtle implication that massage therapists are untrustworthy</p> Signup and view all the answers

    What is a concern about massage therapy and the sex trade?

    <p>Massage therapists are unable to touch breast tissue in a non-sexual manner</p> Signup and view all the answers

    What is a consequence of not addressing our fears and concerns about breast massage?

    <p>All of the above</p> Signup and view all the answers

    What is a concern about the health care profession's perception of massage therapy?

    <p>It is not a valid, complimentary health profession</p> Signup and view all the answers

    What is the name of the glands found in the areola?

    <p>Montgomery Glands</p> Signup and view all the answers

    What is a common indication for breast massage treatment?

    <p>Client requests it</p> Signup and view all the answers

    What is a goal of breast massage treatment?

    <p>Reduce pain, edema and congestion through hydrotherapy</p> Signup and view all the answers

    What is a contraindication for breast massage treatment?

    <p>Mastitis</p> Signup and view all the answers

    What is a technique used in breast massage treatment for scar tissue?

    <p>Fascial techniques</p> Signup and view all the answers

    What is the frequency of breast massage treatment dependent on?

    <p>Condition being treated</p> Signup and view all the answers

    What is a self-care technique recommended for breast massage?

    <p>Appropriate Hydrotherapy</p> Signup and view all the answers

    What determines the prognosis of breast massage treatment?

    <p>Cause of the condition</p> Signup and view all the answers

    What is a goal of hydrotherapy in breast massage treatment?

    <p>Reduce pain and edema</p> Signup and view all the answers

    What percentage of breast lymph drains into the axillary nodes?

    <p>75%</p> Signup and view all the answers

    Which nerve supplies the nipple?

    <p>T4</p> Signup and view all the answers

    What is the result of compression syndromes or nerve damage in breast tissue?

    <p>Pain, numbness, and tingling</p> Signup and view all the answers

    What is unique about the lymphatic channels of the breast?

    <p>They drain from superficial to deep</p> Signup and view all the answers

    Which lymph nodes can accept lymph from both lateral and medial aspects of the breast?

    <p>Internal mammary chain</p> Signup and view all the answers

    What is Thoracic Outlet Syndrome caused by?

    <p>Compression of the arterial, venous, and nerve supply of the brachial plexus</p> Signup and view all the answers

    What is a potential complication of compression or scar tissue in the breast?

    <p>Breast congestion</p> Signup and view all the answers

    What direction do lymphatic drainage techniques typically follow on the breast itself?

    <p>Towards the areola</p> Signup and view all the answers

    What is the typical posture of an infant from 0-3 months?

    <p>Legs, arms and head flexed (fetal position)</p> Signup and view all the answers

    What is the typical duration of infant massage from 0-3 months?

    <p>15-20 minutes</p> Signup and view all the answers

    What is a characteristic of infants from 3-6 months?

    <p>They are more acute to external stimuli</p> Signup and view all the answers

    What is a characteristic of infants from 6-8.5 months?

    <p>They are actively mobile and engage with surroundings</p> Signup and view all the answers

    What is a characteristic of children from 8.5 months-3 years?

    <p>They are very curious, active and exploring</p> Signup and view all the answers

    Why may massage need to be adjusted for children from 8.5 months-3 years?

    <p>They are very curious, active and exploring, and may not want to sit still</p> Signup and view all the answers

    What is the primary goal of infant massage?

    <p>Reducing the stress of the infant</p> Signup and view all the answers

    What is the recommended type of oil to use for infant massage?

    <p>Cold-pressed, unscented oil</p> Signup and view all the answers

    Why should the infant be treated on a blanket-covered pillow?

    <p>To help trap heat</p> Signup and view all the answers

    What technique is used to grasp a tense area within the infant and firmly hold it until the area relaxes?

    <p>Touch Relaxation</p> Signup and view all the answers

    What is the benefit of using a cold-pressed, unscented oil for infant massage?

    <p>It allows the baby to connect with the parent's natural smell, developing an olfactory bond</p> Signup and view all the answers

    What is the secondary goal of infant massage?

    <p>Forging and strengthening the maternal/paternal bonds with the infant</p> Signup and view all the answers

    How should the length of the treatment be determined?

    <p>By the infant (within reason)</p> Signup and view all the answers

    Why is it important for the therapist to observe for 'refusal cues' during the treatment?

    <p>To determine when the infant no longer wishes to continue the treatment</p> Signup and view all the answers

    What is a benefit of increased proximity to the parent for an infant?

    <p>Sothing of the infant</p> Signup and view all the answers

    What is a contraindication for massage therapy in infants?

    <p>Undiagnosed fever</p> Signup and view all the answers

    What is the primary goal of teaching parents massage techniques?

    <p>To empower parents to massage their own child</p> Signup and view all the answers

    What is the definition of colic?

    <p>Episodes of crying more than 3 hours per day</p> Signup and view all the answers

    What is a common outcome of colic cases?

    <p>Self-resolving with no indications of long-term effects</p> Signup and view all the answers

    What is a theory behind the colic phenomenon?

    <p>Evolved infant strategy for garnering attention</p> Signup and view all the answers

    How is diagnosis of colic accomplished in the medical field?

    <p>Through the process of elimination, assessing/testing to remove all other possible causes of infant distress</p> Signup and view all the answers

    What is a special consideration when massaging infants on medications?

    <p>Take special care</p> Signup and view all the answers

    What is the purpose of a radiant warmer or incubator for pre-term infants?

    <p>To maintain body temperature due to lack of body fat</p> Signup and view all the answers

    What is the primary goal of establishing consent before a massage treatment with an infant?

    <p>To obtain the infant's permission and cooperation</p> Signup and view all the answers

    What is the characteristic of the Babinski reflex in neonates?

    <p>Toes curl up</p> Signup and view all the answers

    What is the significance of the Tonic Neck reflex in neonates?

    <p>It helps during active labor</p> Signup and view all the answers

    What is an example of an 'acceptance cue' in an infant during massage?

    <p>Smiling and cooing</p> Signup and view all the answers

    Why is it important to establish a routine for massage treatments with infants?

    <p>To help the infant become more accustomed and comfortable with massage treatments</p> Signup and view all the answers

    What is the recommended approach to seeking consent from an infant before a massage treatment?

    <p>Use a soothing voice tone and warm smile</p> Signup and view all the answers

    What is an example of a 'refusal cue' in an infant during massage?

    <p>Breaking eye contact and turning away</p> Signup and view all the answers

    What is the purpose of incorporating the massage treatment into reading or story time with older infants?

    <p>To keep the infant engaged and interested during the treatment</p> Signup and view all the answers

    What is the significance of the Moro reflex in neonates?

    <p>It is a natural reflex that disappears after 6 months</p> Signup and view all the answers

    When performing the 'belly button smile' technique on the abdomen, what should the therapist do with their thumbs?

    <p>Meet at the naval and perform a light thumb strip bilaterally</p> Signup and view all the answers

    When treating the arms, what should the therapist do first?

    <p>Start at the shoulder and 'milk' distally towards the hand</p> Signup and view all the answers

    What is the primary aim of the 'water wheel' technique on the abdomen?

    <p>To stimulate the peristaltic movement of the digestive system</p> Signup and view all the answers

    When treating the legs, what should the therapist do after 'milking' distally towards the foot?

    <p>Move back up to the hips/glutes and then 'wring' distally towards the foot</p> Signup and view all the answers

    What should the therapist do when treating the face of an infant?

    <p>Work from the forehead down, including the eyebrows and cheeks</p> Signup and view all the answers

    What is the purpose of the 'Touch Relaxation' technique?

    <p>To relax the muscles and promote relaxation</p> Signup and view all the answers

    When treating the back, what should the therapist do after applying the 'water wheel' technique?

    <p>Apply small, circular kneading over the entire back</p> Signup and view all the answers

    What should the therapist do when treating the abdomen of an infant who has been experiencing constipation?

    <p>Utilize PROM of the hips and take the infant through the flexion/extension plane</p> Signup and view all the answers

    What should the therapist do when treating the chest of an infant?

    <p>Use a stroke similar to the 'belly button smile' starting at the sternum and moving laterally along the ribs</p> Signup and view all the answers

    What should the therapist do when treating the hands of an infant?

    <p>Treat the hands specifically with strokes beginning at the palm and moving to the fingers</p> Signup and view all the answers

    Study Notes

    Anatomy and Musculoskeletal Changes

    • Weight gain during pregnancy:
      • Fetus: 7-8lbs
      • Placenta: 1-1.5lbs
      • Amniotic fluid: 1.5-2lbs
      • Uterus and breasts: 5-5.5lbs
      • Blood and fluid: 4-7lbs
      • Muscle and fat: 1-6lbs
      • Total: 20-30lbs
    • Posture changes:
      • Ligamentous laxity due to Relaxin and Estrogen
      • Hyperextension and hypermobility of joints
      • Increased risk of injury and sprain, particularly to lumbosacral, sacroiliac, sacrococcygeal, symphysis pubis, hip, knee, ankle, and foot joints
      • Anterior carriage of weight shifts the center of gravity upward and forward
      • Compensatory posture:
        • Weight shifts to the heels
        • Upper back tilts posteriorly
        • Chin thrusts forward
        • Anterior pelvic tilt
        • External rotation of the hips
        • Hyperextension of the knees
        • Possible pes planus (flat feet)

    Cardiovascular Changes

    • Changes in blood pressure:
      • Heart rate increases by 10-15 beats over pre-pregnancy values
      • Blood volume increases by up to 40% over pre-pregnancy values
      • Cardiac output increases by 30-50%
      • Viscosity of the blood decreases
      • May contribute to cardiac murmurs and mitral valve prolapse
    • Decreased peripheral vascular resistance:
      • Causes a drop in blood pressure, most noticeable in the 2nd trimester
      • May result in supine hypotension, causing dizziness and lightheadedness
    • Vena Cava Syndrome:
      • Occurs in up to 11% of pregnancies
      • Caused by compression of the inferior vena cava, particularly when lying in supine
      • Can be rectified by having the woman turn to a left side-lying position or positioning the woman with a pillow or towel roll under the right hip

    Respiratory Changes

    • Increased oxygen demand and consumption:
      • Increases by 14-20%
      • Diaphragm becomes compressed and elevated, decreasing the vertical height of the lungs by 4cm
      • Thorax compensates by expanding in diameter by approximately 10cm
      • Breathing becomes more costal and less diaphragmatic
    • Dyspnea (difficulty breathing):
      • Affects 60-70% of people during pregnancy
      • Not due to compression of the diaphragm, but rather a change in proprioceptive information transmitted to the brain

    Renal Changes

    • Expansion of the kidneys, bladder, and ureters:
      • In response to the increased demands of pregnancy
      • Polyuria (frequent urination) and nocturia (increased urination at night) affect 80-95% of people
      • Compression of the bladder may increase the sense of urgency
      • Stress incontinence may occur, but usually resolves post-partum
      • Bladder distension may also contribute to incontinence
      • Pyelonephritis (kidney infection) may increase during pregnancy

    Gastrointestinal Changes

    • Decrease in serum glucose levels:
      • Stimulates increased appetite
      • Elevation of taste threshold results in cravings
    • Increased absorption of salt:
      • Increases thirst and water retention
    • Nausea and vomiting:
      • Common in the first 14-16 weeks due to continued progesterone production and fetal waste being metabolized through the mother
    • Decreased intestinal motility:
      • Contributes to constipation

    Metabolic and Endocrine Changes

    • Hormone Relaxin:
      • Hydrates ligaments during the second and third trimester to prepare the pelvis for delivery
      • Not joint-specific, affects all joints
      • Persons with pre-existing joint instability may notice an increase in symptoms
    • Sodium and water retention:
      • Contributes to increased capillary permeability and edema
      • May lead to nerve compression and entrapment syndromes

    Signs and Symptoms of Pregnancy

    • 1st trimester (0-12 weeks):
      • Implantation of fertilized ovum in uterus
      • Nausea and vomiting, constipation, bloating, and indigestion
      • Fatigue due to hormonal changes and increased stress
      • Increased breast size and tenderness
      • Small weight gain
      • Emotional changes
      • Drop in blood pressure
    • 2nd trimester (13-26 weeks):
      • Hormones stabilize
      • Disappearance of breast discomfort and nausea
      • Placenta developed and handling fetal nutrition and waste
      • Visible change in woman's physical appearance
      • Further drop in blood pressure
      • Hormone Relaxin works with estrogen to hydrate and loosen ligaments and pelvic cavity
      • Striae Gravidarum (stretch marks) begin to appear
      • Braxton Hicks Contractions (false labor)
      • Diastasis Recti (separation of the Rectus Abdominus along the linea alba)
    • 3rd trimester (27-40 weeks):
      • Uterus is quite enlarged and has regular contractions
      • Fetal compression of bladder, colon, and stomach
      • Fetal position changes in preparation for birth
      • Increased blood pressure
      • Increased water weight gain and edema
      • Shortness of breath due to fetal compression of diaphragm
      • Fatigue due to increased weight gain, loss of sleep, and nocturia

    Complications of Pregnancy

    • Pre-existing conditions:

      • Diabetes
      • High Blood Pressure
      • Cardiac Abnormalities
      • Neoplasm (tumor or growth)
      • Pulmonary Anomalies
      • Neurological Conditions
      • Systemic Infection
      • Musculoskeletal Conditions
      • Fever
      • Chronic Disability

    • High-Risk Pregnancy-Related or Induced Conditions:

      • Preterm Labor
      • Placenta Previa
      • Placenta Abruptio
      • Incompetent Cervix
      • Pre-term Rupture of Membranes
      • Diastasis Recti
      • Gestational Diabetes
      • Pregnancy Induced Hypertension (PIH)
      • Pre-eclampsia
      • Eclampsia
      • Disseminated Intravascular Coagulation
      • Intrauterine Growth Restriction (IUGR)
      • Hydramnios/Polyhydramnios
      • Oligohydramnios### Treatment Aims

    • General aims: decrease SNS, promote relaxation, treat conditions, encourage full diaphragmatic breathing, promote general health and nutrition, encourage safe exercise, prepare for delivery, provide emotional support, and monitor for ominous signs

    • 1st trimester aims: monitor blood pressure, treat SNS firing, provide symptomatic relief, decrease headaches and nausea, encourage and maintain good circulation, and educate on postural awareness and exercise

    • 2nd trimester aims: monitor blood pressure, address postural changes, maintain general health and exercise, address pre-existing conditions, maintain ROM, decrease trigger points, and maintain tissue health

    • 3rd trimester aims: monitor blood pressure, decrease SNS firing, decrease physical discomfort and trigger points, decrease edema, decrease breast discomfort, decrease constipation, treat conditions, maintain circulation and tissue health, provide emotional support, and monitor for ominous signs

    • Post-partum aims: restore posture and muscle strength, address labor-induced muscle strains or ligament sprains, decrease adhesions, decrease breast discomfort, monitor for Mastitis, and monitor for post-partum depression

    Techniques

    • 1st trimester: positioning adaptations, avoid deep and vigorous massage, and avoid fascial work over the low back or abdomen
    • 2nd and 3rd trimester: client may lie in prone with a "pillow well", side lying, avoid deep pressure over the low back or abdomen, and use techniques such as effleurage, petrissage, and longitudinal stripping
    • Post-partum: avoid deep pressure, focus on restoring posture and muscle strength, and address labor-induced muscle strains or ligament sprains

    Contraindications and Precautions

    • Avoid deep or vigorous massage and fascial techniques over the abdomen or low back in the 1st or 3rd trimester or on anyone with a history of miscarriage
    • Monitor blood pressure before each treatment
    • Avoid abdominal strain, dizziness, and fainting at end of treatment
    • Take precautions for clients with gestational diabetes, lower limb edema, and varicose veins
    • Decrease pressure and avoid direct pressure over varicose veins
    • Do not forcefully mobilize hypermobile joints especially in the low back, sacrum, and pelvis
    • Treatment times may need to be shortened if client is experiencing discomfort

    Breast Massage Overview

    • Breast massage is indicated in treatment when there is a need to improve circulation and drainage, relieve congestion, and address breast tissue health.
    • Consent from the client is essential, and the therapist must explain the rationale for treatment, ensure the client understands their rights, and respect their boundaries.

    Case for Breast Massage

    • Breast tissue health requires adequate circulation and drainage, which can be obstructed by habitually poor posture, tight-fitting undergarments, breast implants, and surgical scarring, leading to breast congestion, chronic pain, and protective holding patterns.
    • Knowledgeable and trained therapists can effectively perform massage techniques and hydrotherapy to enhance blood and lymphatic flow, treating scars and fascial restrictions that contribute to chronic pain and reduced range of motion.

    Anatomy and Physiology

    • The breast contains specialized glandular tissue within the layers of subcutaneous superficial fascia, positioned directly under the skin and sitting over the muscles of the chest wall.
    • The breast relies on fascia and suspensory ligaments (Cooper's Ligaments) for structure and support, and massage therapists should avoid techniques that stress or stretch these structures.
    • Breast tissue anatomical boundaries: upper (lower edge of the clavicle), lower (1" below breast contour), medial (sternal midline), and lateral (anterior edge of Latissimus Dorsi).
    • The glandular structure of the breasts is composed of 15-20 lobes that produce and deliver milk to a nursing infant, with each lobe having 20-40 lobules that open into ductules.

    Arterial Supply and Venous Drainage

    • The branches of the Subclavian artery supply the breast with blood.
    • Venous return originates from a venous plexus deep to the areola and drains into the Internal Mammary Vein running lateral to the sternum and the Axillary vein in the Axilla.

    Lymphatic Supply

    • The skin surface of the breast and areola are richly supplied with tiny, valveless lymphatic channels that run through the breast into the loose connective tissue.
    • Lymphatic channels drain from superficial to deep, and 75% of breast lymph drains into the axillary nodes.
    • Other lymph nodes that drain the breast include the internal mammary chain, rectus abdominus, and subdiaphragmatic nodes.

    Causes of Breast Pain

    • Brachial Plexus Nerve Entrapment Conditions
    • Trigger Points
    • Cervical Rib
    • Angina Pectoris
    • Gall Stones (Cholelithiasis)
    • Esophageal Lesions
    • Pulmonary Tuberculosis
    • Pregnancy or hormonally related breast congestion
    • Lactation
    • Mastitis
    • Duct Ectasia
    • Fibrocyctic Breast Disease
    • Repetitive Arm Movement
    • Restrictive Clothing

    Assessment and Treatment

    • Assessment involves taking a detailed case history, observing postural factors, palpating the breast tissue, and checking for ominous signs such as nipple retraction, discharge, or hard, non-tender lumps.
    • Treatment aims to reduce pain, edema, and congestion, improve local circulation and tissue health, and encourage mobile scar tissue.
    • Techniques used may include hydrotherapy, Swedish and lymphatic drainage, trigger point therapy, joint play, and relaxation, depending on the reason for treatment.
    • Contraindications include mastitis, post-surgical infection, active infection, and undiagnosed lumps.

    Self-Care and Prognosis

    • Clients can be taught self-care techniques such as hydrotherapy, self-massage, and stretching and strengthening exercises.
    • Prognosis depends on the cause of the condition being treated.

    Infant Massage

    • Infant massage is a treatment that can be provided to infants from 0-3 years old, with adaptations for different age groups.
    • The massage duration varies with age:
      • 0-3 months: 15-20 minutes
      • 3-6 months: flexible duration
      • 6-8.5 months: incorporates more limb movement and music
      • 8.5 months-3 years: may need to happen in smaller segments

    Developmental Stages

    • 0-3 months:
      • Multiple neonatal reflexes
      • Infant adopts "inutero posture" (legs, arms, and head flexed)
      • Infant more comfortable in warmer temperatures
    • 3-6 months:
      • Infant more acute to external stimuli
      • Tonic changes in soft tissue (muscles, ligaments, tendons)
      • Infant becoming more mobile (rolling, wriggling, reaching, holding)
    • 6-8.5 months:
      • Infant actively mobile (lifting upper body, pulling, sitting)
      • Infant engages with surroundings (playful, giggling, recognition)
      • Infant regularly changes positions
    • 8.5 months-3 years:
      • Crawling, exploring, very curious and busy
      • Child may not want to lie or sit still for long periods

    Pre-Term Infants

    • Can be kept in Neonatal Intensive Care Unit (NICU) for any length of time
    • Kept in incubator or radiant warmer to maintain body temperature
    • Birth weight: 500 grams (1lb 1 oz) to 2500 grams (5lbs 8 oz)
    • Many facilities see the value and benefits of touch therapy in premature infants and newborns

    Neonatal Reflexes

    • Moro/Startle reflex: 0-6 months
    • Sucking reflex: continues until infant is weaned
    • Rooting reflex: as long as infant is nursing
    • Grasp reflex: 0-5 months; foot lasts up to 8 months
    • Babinski reflex: toes curl up; adults: toes flare open
    • Blink reflex: present at birth
    • Withdrawal reflex: present at birth
    • Tonic Neck reflex: 0-3 months; helps during active labor
    • Massage is something you do WITH the infant, not TO the infant
    • Obtain consent from the infant before starting the treatment
    • Speak directly to the infant, use their name, and ask if they are ready for the massage
    • Establish eye contact, rub hands together, and show open palms to the infant
    • Observe the infant for physical signs of consent or refusal
    • Acceptance cues: continued eye contact, stilling, smiling, cooing, babbling, reaching out, or bringing hands to mouth
    • Refusal cues: breaking eye contact, turning away, crying, fussing, expressions of discontent, squirming, or flailing

    Establishing a Routine

    • Establish a routine to help the infant become more comfortable with massage treatments
    • Consistency helps the infant (and parent) incorporate massage into their daily routine
    • Ways to establish a routine:
      • Consistent time of day (e.g., before nap or sleep time)
      • Consistent day(s) of the week
      • Performing the treatment in the same room/spot
      • Playing the same music during treatment

    Treatment Goals and Considerations

    • Primary goal: reducing stress in the infant
    • Secondary goal: forging and strengthening maternal/paternal bonds with the infant
    • Length of treatment: dictated by the infant (within reason)
    • Observe for "refusal cues" during treatment
    • Treat the infant on a blanket-covered pillow to help trap heat
    • Use a cold-pressed, unscented oil (e.g., Safflower, sunflower, or fractionated coconut oil) as a medium

    Ideal GSM Techniques

    • "Touch Relaxation" technique: a firm static contact that teaches the infant to locate and relax tense areas
    • Chest treatment:
      • "Touch Relaxation"
      • Grasp the infant under the arms and place thumbs on the sternum
      • "Milking" stroke of the rib cage
      • "Belly button smile" technique
    • Legs/Feet treatment:
      • "Touch Relaxation"
      • "Milking" and "wringing" strokes
      • Treat the foot specifically
    • Abdomen treatment:
      • "Touch Relaxation"
      • "Water wheel" technique
      • "Belly button smile" technique
      • Clockwise abdominal treatment
    • Arms/Hands treatment:
      • "Touch Relaxation"
      • "Milking" and "wringing" strokes
      • Treat the hand specifically
    • Face treatment:
      • Obtain "special permission" from the infant
      • Work from the forehead down
      • Thumb strokes from the midline outwards
      • Circular fingertip/thumb kneading over the cheeks
      • Long strokes from behind the ears to the underside of the chin
    • Back treatment:
      • "Touch Relaxation"
      • "Water wheel" technique
      • Circular kneading over the entire back
      • Stroking down the entire back from shoulders to waist

    Contraindications and Precautions

    • Ensure light pressure throughout the treatment
    • Discontinue treatment if the infant withdraws consent
    • Avoid massaging over open skin
    • Avoid massaging when the infant has an undiagnosed fever
    • Avoid massaging at the site of acute infection
    • Take special care when massaging infants on medications
    • Massage can usually be performed in most states of ill health, with simple, soft touch being therapeutic and soothing

    Baby Colic

    • Definition: episodes of crying more than 3 hours per day, more than 3 times per week, in an infant between 2 weeks and 4 months old, who is otherwise healthy
    • Causes: officially unknown, but several theories have been proposed
    • Assessment/Differential Testing: diagnosis is accomplished by the process of elimination, assessing/testing to remove all other possible causes of infant distress

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    Description

    Learn about the role of massage therapy in a healthy pregnancy, including treating aches and pains, and acting as an educator and advocate for the pregnant person.

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