Pregnancy Massage – Physiological Changes

Pregnancy Massage Physiological Changes for Massage Therapists/Massage Students

Area of change  Changes suggestions for massage/bodywork
Abdominal wall
  • fascia, muscle, skin stretches
  • stretch marks may appear
  • rectus abdominus under considerable strain
  • linea alba may give way  ( diastasis recti)
  • abdominal contents protrude at midline
  • cross-fiber attachments of obliques along rib cage to relieve tension
  • avoid direct abdominal work
  • enlarged and sensitive by the 8th week
  • increased vascular supply
  • 5th month preparation for lactation
  • stretch marks
  • chloasma around nipples and areola
  • drier or oilier
  • acne
  • stretch marks
  • linea nigra -brownish streak down mid-line of abdomen
  • chloasma (mask of pregnancy) around eyes and in labia majora/minora
  • apply cocoa butter
  • apply the following mixture:      1/2 c virgin olive oil, 1/4 c aloe vera gel, 6 capsules vitamin E oil cut open, 4 capsules vitamin A cut open. Mix and store in refrigeration. Apply daily. 
Pelvic floor
  • stretches in preparation for labor
  • stretches due to extra weight of baby
  • Stretch adductor muscles
  • kegel exercises for strengthening
Circulatory system
  • heart size increases and moves anteriorly (upward and to the left)
  • expansion of vascular channels
  • blood volume increases 30-50% 
  • increase in red and white blood cells
  • interstitial fluid volume increases 40% in 3rd trimester causing edema in legs
  • femoral venous ( sapphenous, iliac, femoral, parametrial) pressure increases due to pressure of enlarging fetus on pelvic veins causes varicose veins and edema


  • Women with underlying heart disease at greatest risk for heart failure in 3rd trimester.
  • Use caution when working on legs as an increase in blood clots can occur.
  • Adductor muscles need to relax to relax the pelvic floor
  • Use side lying position
  • increased breathing rate-possibly hyperventilation
  • lower rib cage flares out and diaphragm elevates to make room for the baby
  • accessory muscles used for breathing (scalenes, external intercostals, pec minor)
  • Teach breathing 
  • release scalenes, intercostals, pec minor
  • release all rib cage areas
Gastrointestinal and Urinary
  • saliva becomes more acidic increasing tooth decay
  • excessive gum bleeding
  • gastric acidity and vomiting in 1st trimester
  • peristaltic activity and muscle tone of colon decreased causing constipation
  • increased pressure on sigmoid colon causes constipation
  • 20th week: stomach pushed upward into left dome of diaphragm may cause hiatal hernia
  • gall bladder emptying increases
  • urinary infections common
  • bladder capacity decreases as uterus enlarges
  • Work with reflexology to stimulate digestion
  • Have mother urinate before session whether she needs to or not.  Be prepared for her to get up and go during session.
  • 10 weeks -hormone relaxing produced relaxing the ligaments in SI joint and symphysis pubis; also affects other ligaments
  • general decrease in myofascial pain
  • weight bearing joints placed under more stress due to weight gain and postural changes
  • weight gain in front of body causes woman to lean back changing the center of gravity allowing the pelvis to rotate forward, placing more stress on the SI joint, lumbar spine and stretches abdominals
  • other muscles stressed; pectoral, abdominals, QL, pelvic floor, erector spinae, iliopsoas
  • Increase their awareness of the connection between breath and relaxation
  • Work psoas of women before pregnancy
  • check position of tailbone
  • increase in size and output of pituitary, thyroid, parathyroid, adrenal glands
  • estrogen targets thighs, buttocks, hips to store extra fat
  • estrogen increases size of uterus, cervix, genitals, breasts
  • estrogen decreases stomach acid which can lead to heart burn and indigestion
  • progesterone relaxes smooth muscle and dilates peripheral blood vessels, leading to decrease in peristaltic activity, urinary bladder dysfunction, hemorrhoids, varicose veins and edema.
  • do not do any reflexive work that stimulates endocrine  points

Pregnancy Massage – Benefits of Massage and Stages of Pregnancy

Pregnancy Massage Contraindications and Warnings

Pregnancy Massage – Physiological Changes – Chart

Pregnancy Massage Resources – Free Online Articles,  Books/DVD’s,  Classes