Some massage practitioners refuse to give massage during the first trimester as this is when most miscarriages occur. This is merely because they do not want to be associated with this event should it happen. However, there is no evidence that massage can lead to a miscarriage and massage is not contraindicated during the first trimester. In fact, massage at this time is entirely necessary since it supports a woman as she negotiates the physical, emotional and spiritual changes of her pregnancy. Her potential is maturing into a powerful new role and identity.
2) Massage on the legs during pregnancy
Deep vein thrombosis in the legs only occurs in 15 out of 10 000 pregnant women (data from live births in Olmsted County between 1966 and 1995). Of these 12 will have clear signs of a possible blood clot, leaving 3 out 10 000 pregnant women with an undiagnosed blood clot 출장. Despite these low figures, some massage practitioners indicate that massage work on the inner leg is not advisable as it might dislodge an undiagnosed clot. Keeping in mind that massage improves blood flow and thus reduces the risk of a blood clot forming, refusing to give a competent massage on the legs potentially exposes 9997 out of 10 000 pregnant women to unnecessary risk.
A more realistic approach is to give a competent massage while checking for any signs and symptoms of a possible blood clot. The simplistic solution of prohibiting deep massage or massage altogether on the inner legs appears to be more prevalent in countries where litigation is high and seems to be based on misunderstanding and fear rather than on existing evidence-based practice for the following reasons:
- In spite of this exaggerated emphasis on blood clots, no reliable method is given to assess whether a blood clot is present so there is no good reason to either proceed with or stop the massage. Homan’s test is still routinely taught in massage schools to test for deep vein thrombosis even though it is unreliable and is no longer used, other clinical tests being used in its place.
- Massage helps prevent clots from forming by preventing a build up of stagnant blood in the legs. It is very necessary during pregnancy as there is stronger tendency for blood to clot during pregnancy.
- Pregnant women who have been put on bed rest are at greater risk of developing blood clots as their inactivity causes blood to pool in the legs. They are advised to exercise their legs by pointing the foot up and down. This creates a strong pumping action in the calves which helps keep blood flowing through the legs. This has a more powerful effect than massage or work on pressure points. If massage is considered risky, then standard hospital care is even riskier.
- The Spleen, Liver and Kidney meridians of Traditional Chinese Medicine play an important role in health, especially during pregnancy. As they run through the inner legs, work on pressure points in the legs can be extremely beneficial. In particular, it substantially reduces risk in diabetic mothers when their diabetes is a Spleen and Kidney Yang Deficiency type diabetes (here there may not be the excessive thirst, hunger, urination or heat normally associated with diabetes but there is increased risk of incompetent cervix, placenta praevia and detached placenta). Giving only a light, superficial leg massage in this case may expose the mother to far greater risk than a massage of normal, firmer pressure.