Is Deep Tissue Massage safe during pregnancy?

Yesterday, we received a phone call from a woman in her third trimester whose back was throbbing. She had been desperately looking for somebody to do a deep tissue massage. We get this type of phone call a lot.  

The pregnant woman asked, "Can I get a deep tissue massage while pregnant? Because everybody is refusing!"

Our answer was: "Yes! Of course, you can!"

But that doesn’t mean you can FIND deep tissue massage during pregnancy. In fact, you may need to hunt around before you find it. A lot of spas and massage centers have a "house policy" to avoid doing any deep tissue work on pregnant women. 

What’s up with that? Is it a real safety issue? We made some phone calls and did some research. 

Barriers to Deep Tissue Massage in Pregnancy

Recently, I made a bunch of phone calls to some of my favorite spas in San Diego to find out about their prenatal massage services. How much they charge, positioning, duration, and any special limitations (for example, no massage during the first trimester). Overall, I was quite impressed with the way the spa staff answered my questions, but one thing really stood out as the spas kept emphasizing it: light to medium pressure only!

In fact, one of the spa's literature specifically defines prenatal massage as “light to medium in pressure more like a traditional Swedish massage.” Others I spoke with verbally confirmed the same.

This is actually one of the issues we discuss with new clients as they come in for their first massage. It is very common for pregnant people to have received a prenatal massage elsewhere and have not received enough pressure.

Most pregnant people we talk to think this practice is pure insanity. In fact, they end up scheduling prenatal massages precisely because they want pressure on their aching backs and hips. And then the massage doesn’t deliver.

Pregnant Women are “Fragile”. Underlying these house policies for “no deep massage” is a culture-wide sense of pregnant women as fragile. Massage should simply be pampering and relaxing. This is not based on any evidence (nor most pregnant people’s personal experiences). 

Uneven Training. It is absolutely possible to find a highly qualified, certified prenatal massage therapist at a spa or massage center. But in reality, the training of the staff is pretty uneven. It’s unfortunately a common practice for a spa to send one therapist off to a training session and then that therapist trains the other staff upon their return. A lot of the staff might have received a few hours of training in school, but are not certified nor truly specialized.  

Turnover time. Have you ever thought about what happens when your massage is over at a spa or massage franchise? The massage therapist has about 5 minutes to refresh the room, including changing the sheets and cleaning equipment. And, hopefully they have enough time to take a sip of water and use the restroom. But the clock is ticking! The next client would not appreciate losing a single precious moment of their massage. In this environment, the massage therapist does not have a lot of time for a thorough intake to talk about your overall health and pregnancy. 

Charge more for Deep Tissue? In a lot of spas and massage centers, you pay more for deep tissue massage. Spa management sees it as a measurable element they can parse out and put a price tag on. In reality though, deep tissue massage doesn't need to be deep pressure over every last inch of your body for every last second of the massage. You may need some deeper pressure on your shoulders, but not on your legs. Depending on how they were trained, massage therapists may find deep tissue massage exhausting work and charge more for this effort. Other therapists see deep tissue massage as something is customized and added in as needed to the massage in certain areas of the body.

Liability. With uneven training and the lack of time for a thorough intake before each massage, spas and massage centers are playing it safe and minimizing their risk. They see a lot of people and have a lot of therapists. Avoiding deep tissue massage could very well be a smart move on their part — if their therapists performing prenatal massages are minimally or unevenly trained and have limited experience, perhaps it is prudent for them not to offer deeper, more involved massage that safely respects all the contraindications for pregnancy.

Whether or not you can get deep tissue massage during pregnancy should be YOUR decision, based on your needs, your pregnancy, and your health.

But is Deep tissue bodywork safe in pregnancy?

Yes, pregnant women can safely receive deep tissue massage. Deep tissue work is often indicated given the many structural changes happening to a pregnant person’s body over a short period of time. But a pregnancy massage — deep tissue or not — is always going to be RESPONSIVE and RESPECTFUL to the changes happening in your body. Let’s break it down!

Safe deep pressure is responsive pressure.

Have you ever wondered how a massage therapist knows how much pressure to apply? Do they “turn a dial” and increase or decrease pressure depending on whether the client wants light, medium, or deep pressure? Perhaps they push with a certain level of force or use a certain percentage of their body weight? Good deep tissue massage is actually much more dynamic (and subjective) than that. Good pressure in a massage is only partly about the amount of force the therapist is generating. It’s more about how the therapist is interacting with your tissues – which could be different from day-to-day and different on different parts of your body.

Tool Therapists can use different tools to apply pressure. A sharp elbow offers a different quality of pressure than the palm of the hand. They might change the tol used throughout the massage to deliver pressure to different

Fast, Slo Pressure can be applied at a different tempo — slow, fast, and even rhythmically. A massage therapist needs to read your tissue and change the speed.

Tissue resistance Deep pressure should be applied to the level of tissue resistance. A therapist is not simply applying pressure — they are reading your tissue. They are feeling for resistance and resiliency.

Tissue state Muscle tension is only one element that influences how the pressure feels in a massage. Local inflammation and increased fluid can make pressure feel more painful. Sometimes, people who loved deep pressure before getting pregnant might find that how much pressure they want has changed. This might be a result of the overall increase in bodily fluids during pregnancy.

But how deep is ok? Massage should not hurt. Intense is ok. But you should still be able to breathe comfortably through even deeper work.

Deep tissue massage must respect all the safety precautions for prenatal massage.

Earlier this year, a client came to us who had been on modified bed rest for preterm labor for 10 weeks already, and she was still only about 32 weeks along. Her doctor cleared her for massage, but told her to make sure the massage therapist avoided abdominal massage and did no deep tissue work. As MTs, we care for you, but are NOT your caregiver and we always respect you and your pregnancy by respecting any restrictions that your MD or midwife establishes (and secretly, we are thrilled they are being thoughtful about massage!!). But it’s important to remember that MDs are not experts in massage and sometimes they are making some generalized comments out of caution. 

Both the client and therapist thought some deeper work might be helpful to her. So we messaged her doctor. We were able to clarify for her doctor, that not only was abdominal massage always contraindicated for a woman who was on bed rest, but that localized, slow, gentle deep tissue massage might actually be beneficial. The doctor was completely on board with the idea of tension-relieving deeper work that was restricted to the client’s back and neck and that she experienced as pleasurable, avoiding pain and stress responses.

In pregnancy, whether it is deep tissue massage or more gentle massage, we always avoid deeper work on the abdomen. We always follow strong precautions when massaging the legs so as to respect the challenged vascular tissue there and prudently follow protocol to avoid interfering with any potential blood clots (of which there is an increased risk in pregnancy), really minimizing any deeper work on those legs. We also respect the client’s pregnancy by knowing and avoiding acupressure points from Chinese medicine and reflexology that either stimulate labor or are not supportive of the pregnancy. We also always position and support the client’s body in a way that avoids pressure on her abdomen and uterus.

What's the conclusion here for YOU as you are trying to schedule a deep tissue massage during your pregnancy? If you are experiencing a healthy pregnancy that is progressing normally, there is probably no overarching contraindication to some deeper work. However, ask yourself what feels right in your own body. And find a therapist who can speak smartly to you about any deeper work you want. What type of training do they have? How experienced are they? And ask them what limitations they would use with you. Talk to the therapist!