Relaxing Prenatal Massage Sessions Webinar #4 of Growing a Prenatal Massage Therapy Practice Carole Osborne In this Webinar You Will Learn Therapeutic principles of prenatal massage therapy Where to begin and what to include in a relaxing prenatal massage in side lying position A step-by-step sequence that will benefit most pregnant women Alternatives for other circumstances Questions to Consider 1. What types of MT techniques are the most appropriate for relaxing pregnant women? 2. What is one of the most important principles for relaxing prenatal massage sessions? 3. Under what circumstances might starting a session with your hands on the client s abdomen be appropriate? 4. What are some of the body areas where safety precautions require broad rather than pointed pressure, especially when deeper pressure is desired? 5. Why is repetition of the lumbosacral stretch likely to be effective for pregnant clients? 6. What common complaint will lighter pressure on the legs be more likely to help than heavier pressure? 7. What types of complaints might indicate that deeper pressure on safe areas might be indicated? 1
Primary Therapeutic Principles First, do no harm Work within your skill and knowledge base Perform individualized client assessment for prenatal and pre-existing conditions/injuries Primary Therapeutic Principles Create safe, comfortable and stable positioning Adjust speed & depth of pressure to avoid sympathetic NS arousal Communicate with client Primary Therapeutic Principles Make specific methodological variations Maintain scope of practice Collaborate, not replace midwife or doctor 2
Where to begin a relaxing prenatal massage? Connecting with mom & baby On lower back or maybe belly At your familiar/favorite starting point At her complaint area Guiding her breathing On her head or feet What to include? Breath enhancement Pain relief Internal focus Edema relief for legs & arms What to Include? Relieve strain to sacroiliac, lumbosacral & hip joints Autonomic sedation 3
What to Include? Active listening Appropriate educational activities B O D Y M E C H A N I C S Body Mechanics Shift weight into client from rear leg Adjust table height to between wrist and knuckles Side lying Positioning & Draping 4
Words of Experience Start with a solid confidence in your positioning. Practice on the nonpregnant clients you are most comfortable with ( of all sizes and shapes ) and that will help tremendously. Get to know your pillows or the system you are using. Being tentative causes uncertainty for her while showing confidence will help her to feel she is in good hands. Begin the massage with relaxing her and remind her to breathe...this will also help to ground and center you. Nanci Newton Connection Core Posterior pelvis Abdomen (if established relationship & consent) Breathing awareness Lumbo-sacral stretch Broadly distributed pressure on sacrum (See p.91 Pre-and Perinatal Massage Therapy, 2e) 5
Occipital circles Stand facing head or foot end of table Uncover back Shape along panty line just superior of gluteal cleft. Tuck between table and gluteals/upper thigh. Paravertebral walk Rhythmic alternation down and up lateral of spine 6
B O D Y M E C H A N I C S Body Mechanics Lengthen spine Shift weight into client from rear leg Keep front leg empty Paravertebral walk body mechanics Check that you are upright, not sidebent toward your hands. Spread lubricant Perhaps ceiling side of back only 7
Fanning Both directions Superficially Deeply into laminar groove Fanning body mechanics Leaning weight from rear leg directly into client. Front leg remains empty. Hand movements powered by legs, directed by pelvis. Fanning Superior of iliac crest Inferior of iliac crest 8
Fingertip raking In muscular level, between 12 th rib and iliac crest No more anterior than edge of quadratus lumborum Lumbosacral stretch #2 Broadly distributed pressure over sacrum Hold for 30-60 seconds B O D Y M E C H A N I C S Body Mechanics Lengthen spine Shift weight into client from rear leg Balance shoulder, elbow, wrist alignment 9
Return to upper body Effleurage, fanning or cross fiber slide Upper back sweep Broad pressure over mid-shoulder/gb-21 point Scapula scrape & mobilization Working under and around all scapular attachments 10
Arm & wrist work Effleurage, kneading, stripping, mobilization of wrist and fingers Laminar groove slide Returning to pelvic girdle Lumbosacral stretch #3 Never too much of a good thing 11
Cover back/uncover leg & lateral pelvis See webinar #2 of this series for full sequence of leg draping Kneading gluteals Knuckles, forearm or elbow Circling greater trochanter Either direction Gradually increasing depth 12
Superficial leg work Targets edema relief primarily with light pressure, draining proximal regions first, and stroking primarily toward pelvis Deeper leg work Targets soft tissue relief Safe on lateral, anterior and posterior leg if no vascular weakness Peroneal strokes Focused on peroneal tension 13
B O D Y M E C H A N I C S Body Mechanics Lengthen spine Shift weight into client from rear leg Balance shoulder, elbow, wrist alignment Adjust table height to between wrist and knuckles Keep front leg empty Foot and ankle Mobilize, knead, stretch Broad, more superficial pressure over precautionary reflex points Avoid plantar flexion to protect from calf cramps Medial leg Broad, superficial strokes on medial calf and thigh 14
Turn over to other side and repeat Check with client on need to urinate before continuing Foot hold to finish Or back to how started connection with core Lumbosacral stretch to finish 15
Abdominal massage to finish Maximum 3-5 minutes, unless positioned to avoid supine hypotensive syndrome Alternatives for Other Circumstances Nausea & digestive discomforts Heartburn & shortness of breath Alternatives for Other Circumstances If soft tissue pain & joint strain are primary issues, include more: Deep tissue Myofascial Trigger point Cross fiber friction Rhythmic movement Resisted & positional Remember to maintain level for autonomic sedation 16
Growing a Prenatal MT Practice Webinar 1. Trimester Developments & Women s Prenatal Needs recorded 3/12/13 2. Making Nurturing Spaces for Moms and Babies recorded 3/19/13 3. Prenatal Massage Therapy Practicalitiesrecorded 3/21/13 4. Relaxing Prenatal Massage Sessions 5. Interacting Within the Perinatal Healthcare System 6. Marketing a Mommies R Us MT Practice Pregnancy 101 Series Pre-recorded 1. Fostering a Healthy Pregnancy * 2. Cardiovascular Adaptations 3. Respiratory and Digestive System 4. Musculoskeletal Adaptations-back & pelvis* 5. Musculoskeletal Adaptations-other areas 6. Practice-Based Decision Making (Each available individually except #6 only available if purchase all 6 webinars. Studying in all 6 webinars highly recommended for a more complete understanding.) *most applications to this webinar New Class! 17
Certification in Pre- and Perinatal Massage Therapy Distinguish yourself and develop the prenatal practice of your dreams by earning THE maternity massage certification many hospitals & employers require. Practice and receive personalized feedback in: deep tissue passive movement neuromuscular reflexive positional release Plus other somatic methods modified to support pregnancy, laboring and postpartum women Carole has always been a model for integrity and professionalism. Learning from her and her instructors is what has motivated me to stay committed to this vital work and to do my best always. Salt Lake City MT For schedule & more info: www.bodytherapyeducation.com Carole Osborne s Prenatal and Deep Tissue Massage Training Further Information and Training 1. Benefits of Prenatal and Perinatal Massage Therapy 2. General Guidelines, Precautions, and Contraindications 3. Client Positioning, Draping, Body Mechanics, and Other Practical Considerations 4. Trimester Recommendations and Techniques 5. Massage Therapy as Labor Support 6. Postpartum Perspectives and Techniques 7. Clients with Special Needs 8. Business Considerations 214 pgs; 90 minutes of technique videos 9. Profiles of Maternity Massage Therapists Free Educational Videos Carole s videos are at www.bodytherapyassociates.com/videos.php or YouTube Smooth Moves Between Side- Lying and Semi-Reclining Position Adapting a General Massage for Sidelying Breast Draping for Side Lying Massage Contrasting Pillows and the Side Lying Positioning System Peripartum Pelvic Pain Advantages of Sidelying Tips for Sidelying Positioning Secure SL Draping SL Body Mechanics Massage of the Legs Rhythmic Deep Tissue for Neck Side Lying Approach to Piriformis Syndrome Top 10 Tips for Great Side Lying Positioning Oakworks Educational Videos at www.massagetabl es.com/videos/ed ucationalseries.asp 18
References Consulted for this Webinar Andrade C-K and Clifford P. Outcome-Based Massage, 2 nd Ed. Baltimore: Lippincott, Williams, and Wilkins, 2008. Osborne C. Pre- and Perinatal Massage Therapy, 2 nd Ed. Baltimore: Lippincott, Williams, and Wilkins, 2011 Ostgaard HC, Andersson GBS, Karlsson K. Prevalence of back pain in pregnancy. Spine 1992;17:53 55. Pryde M. Effectiveness of massage therapy for subacute low-back pain. A randomized controlled trial. Can Med Assoc J 2000;162(13): 1815 1820. Ricci S. Essentials of Maternity, Newborn, and Women s Health Nursing. 2nd Ed. Baltimore: Lippincott Williams & Wilkins, 2009. Stager L. Nurturing Massage for Pregnancy. Baltimore: Lippincott, Williams and Wilkins, 2010. Yates S. Pregnancy and Childbirth: A holistic approach to massage and bodywork. Edinburgh: Churchill, Livingstone, 2010. Terms of Participation for Growing a Prenatal Practice Webinars I realize that the health and well-being of my clients and their offspring are influenced by my understanding and application of this material; therefore, I am committed to the conscientious study and thorough absorption of the information presented in this webinar. I understand that this webinar offers reliable, yet limited education in prenatal massage therapy. I understand that it does NOT include labor, postpartum, or any clinical or hands-on instruction or evaluation; therefore, this is NOT a certification program. I agree not to represent myself directly or by implication in marketing activities or any communications to clients or others that I am certified, endorsed, or authorized by the Benjamin Institute or by Carole Osborne, Body Therapy Education, or any other agency to practice or teach prenatal massage therapy on the basis of participation in this webinar. I recognize that, on the basis of this webinar, I am especially not prepared to work with those women whose pregnancies are complicated by medical conditions or a higher risk of complications developing; therefore, I will refer these individuals to others more thoroughly educated and certified in this specialization if I don t have adequate training from another source. The safety and health of the expectant woman and her child (children) are my foremost concern; therefore, I will seek guidance from her prenatal healthcare provider prior to providing services. If I have any doubt as to the prudence of any somatic practices for my pregnant client, I will refrain from such procedures and seek guidance from her prenatal healthcare provider regarding her care. I agree to conduct my practice of prenatal massage therapy in accordance with the ethical and legal guidelines of the organizations to which I belong or by which I am licensed or registered. Thank you! Questions? Carole Osborne s Prenatal and Deep Tissue Massage Training 19
Webinars Available On Demand Dr. Ben Benjamin Unraveling the Mystery Series: Low Back Pain Cervical Pain Shoulder Pain Knee Pain Ankle Pain Hip & Thigh Pain Tom Myers Anatomy Trains: Clinical Applications of Myofascial Meridians Beyond Good Posture And Many More Whitney Lowe Orthopedic Approaches to Upper Body Disorders Orthopedic Approaches to Lumbo-Pelvic Pain Carole Osborne Pregnancy Massage 101 Tracy Walton Massage in Cancer Care Cardiovascular Conditions & Massage Hospital-Based Mssage All Webinars Available at www.benbenjamin.com JOIN The Benjamin Institute E-Mailing List & Receive a FREE Ebook on the Low Back 59 Keep Learning www. BenBenjamin.com/Webinars.php 60 20